Healthcare Provider Details

I. General information

NPI: 1902888217
Provider Name (Legal Business Name): MICHAEL STAMPAR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MARION AVE UNIT 1314
PUNTA GORDA FL
33950-4467
US

IV. Provider business mailing address

201 W MARION AVE UNIT 1314
PUNTA GORDA FL
33950-4467
US

V. Phone/Fax

Practice location:
  • Phone: 941-505-0888
  • Fax: 941-505-0890
Mailing address:
  • Phone: 941-505-0888
  • Fax: 941-505-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberOS7178
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberOS7178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: