MEDICARE: STEPHEN GEORGE CALABRESE 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	207L00000X	Anesthesiology Physician	DR.0067117	CO
2	207L00000X	Anesthesiology Physician	MD23783	ME
3	207L00000X	Anesthesiology Physician	S1994	TX
4	207L00000X	Anesthesiology Physician	ME154263	FL

General Provider Information

NPI Number	:	1790139459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN GEORGE CALABRESE MD

Provider Business Mailing Address
First Line	:	11561 CARAWAY LN APT 187
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-1232
Country	:	US
Telephone Number	:	908-500-0577
Fax Number	:

Provider Business Practice Location Address
First Line	:	11561 CARAWAY LN APT 187
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-1232
Country	:	US
Telephone Number	:	908-500-0577
Fax Number	:

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

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	08/19/2022

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