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NPI Code Detail

MEDICARE: DR. STEPHEN K BADOLATO MD

MEDICARE: DR. STEPHEN K BADOLATO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QS0010XSports Medicine (Family Medicine) PhysicianME78710FL

General Provider Information

NPI Number : 1194728832
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN K BADOLATO MD
Provider Business Mailing Address
First Line : 247 LANSING ISLAND DR
Second Line :
City : INDIAN HARBOUR BEACH
State : FL
Zip : 32937-5102
Country : US
Telephone Number : 321-253-2169
Fax Number :
Provider Business Practice Location Address
First Line : 6300 N WICKHAM RD
Second Line : STE 101 -108
City : MELBOURNE
State : FL
Zip : 32940-2028
Country : US
Telephone Number : 321-253-2169
Fax Number : 321-253-1720
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2005
Last Update Date : 10/22/2007

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Directions to “ DR. STEPHEN K BADOLATO MD” Practice Location

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