MEDICARE: STEPHANIE BURGOS 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	207P00000X	Emergency Medicine Physician	ME125094	FL

General Provider Information

NPI Number	:	1366731846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BURGOS M.D.

Provider Business Mailing Address
First Line	:	10896 LEMON LAKE BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-5040
Country	:	US
Telephone Number	:	917-763-7102
Fax Number	:

Provider Business Practice Location Address
First Line	:	4409 HOFFNER AVE # 405
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-2331
Country	:	US
Telephone Number	:	917-763-7102
Fax Number	:

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

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	12/31/2024

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