Healthcare Provider Details

I. General information

NPI: 1790779320
Provider Name (Legal Business Name): BRUCE C STEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 N MILLS AVENUE
ORLANDO FL
32803-4504
US

IV. Provider business mailing address

1745 N MILLS AVENUE
ORLANDO FL
32803-4504
US

V. Phone/Fax

Practice location:
  • Phone: 407-841-7151
  • Fax: 407-648-2259
Mailing address:
  • Phone: 407-841-7151
  • Fax: 407-648-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME80836
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME80836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: