Healthcare Provider Details

I. General information

NPI: 1679487805
Provider Name (Legal Business Name): STEALTH MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 N ANDREWS AVE APT 531
FORT LAUDERDALE FL
33309-2486
US

IV. Provider business mailing address

6500 N ANDREWS AVE APT 531
FORT LAUDERDALE FL
33309-2486
US

V. Phone/Fax

Practice location:
  • Phone: 954-803-1996
  • Fax:
Mailing address:
  • Phone: 954-803-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: PHILL WHITMAN
Title or Position: COO
Credential:
Phone: 954-803-1996