MEDICARE: STEPHEN PAPPACHEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	ME88723	FL
2	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	ME88723	FL

General Provider Information

NPI Number	:	1063418580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN PAPPACHEN M.D.

Provider Business Mailing Address
First Line	:	1241 VISTA HILLS DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-5642
Country	:	US
Telephone Number	:	863-255-6092
Fax Number	:

Provider Business Practice Location Address
First Line	:	1241 VISTA HILLS DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-5642
Country	:	US
Telephone Number	:	863-255-6092
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	03/19/2020

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