Healthcare Provider Details

I. General information

NPI: 1205416757
Provider Name (Legal Business Name): STEPHEN JOSEPH PATACSIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20900 BISCAYNE BLVD
AVENTURA FL
33180-1407
US

IV. Provider business mailing address

536 N THOMPSON RD
APOPKA FL
32712-3804
US

V. Phone/Fax

Practice location:
  • Phone: 305-682-7000
  • Fax:
Mailing address:
  • Phone: 407-462-4518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number110905
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: