Healthcare Provider Details

I. General information

NPI: 1134514052
Provider Name (Legal Business Name): STEPHANIE L LOGTERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-3040
  • Fax: 321-841-3049
Mailing address:
  • Phone: 321-841-3040
  • Fax: 321-841-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME155679
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMT219765
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: