Healthcare Provider Details

I. General information

NPI: 1467719658
Provider Name (Legal Business Name): ELLEN STOLLE SATTESON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN CAROLINE STOLLE M.D.

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4037 NW 86TH TER
GAINESVILLE FL
32606-9277
US

IV. Provider business mailing address

PO BOX 100138
GAINESVILLE FL
32610-0138
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-8402
  • Fax:
Mailing address:
  • Phone: 352-273-8670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME140790
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: