Healthcare Provider Details

I. General information

NPI: 1942233077
Provider Name (Legal Business Name): STEPHEN E OLVEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NW 12TH AVE BOX 016960 ( M851)
MIAMI FL
33136-1002
US

IV. Provider business mailing address

1475 NW 12TH AVE BOX 016960 ( M851)
MIAMI FL
33136-1002
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-4058
  • Fax: 305-243-8470
Mailing address:
  • Phone: 305-243-4058
  • Fax: 305-243-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME69107
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberME69107
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: