Healthcare Provider Details

I. General information

NPI: 1962817189
Provider Name (Legal Business Name): MIKE STUNTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 08/16/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25232 ST ROAD 54
LUTZ FL
33559-6244
US

IV. Provider business mailing address

43309 US HIGHWAY 19 N
TARPON SPRINGS FL
34689-6221
US

V. Phone/Fax

Practice location:
  • Phone: 813-953-1170
  • Fax: 813-953-1061
Mailing address:
  • Phone: 727-938-2020
  • Fax: 727-938-5606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME143814
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: