MEDICARE: DR. STEPHANIE STEPHEN MATTATHIL 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	208M00000X	Hospitalist Physician	ME158898	FL
2	207RC0000X	Cardiovascular Disease Physician	ME158898	FL
3	207R00000X	Internal Medicine Physician	ME158898	FL
4	207RA0001X	Advanced Heart Failure and Transplant Cardiology Physician	ME158898	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225415466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE STEPHEN MATTATHIL M.D

Provider Business Mailing Address
First Line	:	3003 W DR MLK BLVD FL JRBLVD2
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6307
Country	:	US
Telephone Number	:	813-586-8079
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 W DR MLK BLVD FL JRBLVD2
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6307
Country	:	US
Telephone Number	:	813-586-8079
Fax Number	:

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

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	03/17/2026

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Directions to “ DR. STEPHANIE STEPHEN MATTATHIL M.D” Practice Location

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