Healthcare Provider Details

I. General information

NPI: 1982681490
Provider Name (Legal Business Name): STEPHEN L HELGEMO JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18344 MURDOCK CIR
PORT CHARLOTTE FL
33948-1008
US

IV. Provider business mailing address

18344 MURDOCK CIR
PORT CHARLOTTE FL
33948-1008
US

V. Phone/Fax

Practice location:
  • Phone: 941-625-6547
  • Fax: 941-629-6415
Mailing address:
  • Phone: 941-625-6547
  • Fax: 941-629-6415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME0072747
License Number StateFL

VIII. Authorized Official

Name: STEPHEN L HELGEMO JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 941-625-6547