MEDICARE: DR. STEVEN MYLES PORTMAN MD

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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	ME 94421	FL
2	2084N0400X	Neurology Physician	ME94421	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	:	1427141993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN MYLES PORTMAN MD

Provider Business Mailing Address
First Line	:	6151 LAKE OSPREY DRIVE
Second Line	:	3RD FLOOR
City	:	SARASOTA
State	:	FL
Zip	:	34240-8436
Country	:	US
Telephone Number	:	941-355-0077
Fax Number	:	941-907-3476

Provider Business Practice Location Address
First Line	:	6151 LAKE OSPREY DRIVE
Second Line	:	3RD FLOOR
City	:	SARASOTA
State	:	FL
Zip	:	34240-8436
Country	:	US
Telephone Number	:	941-355-0077
Fax Number	:	941-907-3476

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/04/2011

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