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General NPI Number Information
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NPI Number | 1093395303
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Entity Type | Individual
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Provider Name | MICHAEL STEFAN GRAVENSTEIN MD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2021
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 101 N MONROE ST
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City | TALLAHASSEE
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State | FL
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Zip | 32301-1549
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Country | US
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Telephone | 833-351-8255
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 24449
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City | NEW YORK
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State | NY
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Zip | 10087-0589
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Country | US
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Telephone | 833-351-8255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 340977
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | DR.0076030
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 37189
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License Number State | NE
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME178234
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License Number State | FL
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