=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144286428
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEITH B STOLTE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2006
-----------------------------------------------------
Last Update Date | 05/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10441 QUALITY DR. SUITE 303
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-666-9990
-----------------------------------------------------
Fax | 352-666-1905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10441 QUALITY DR. SUITE 303
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-666-9990
-----------------------------------------------------
Fax | 352-666-1905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | ME43218
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------