MEDICARE: STEPHEN EDWARD MITTELDORF 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	207R00000X	Internal Medicine Physician	ME78671	FL

General Provider Information

NPI Number	:	1821071705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN EDWARD MITTELDORF MD

Provider Business Mailing Address
First Line	:	2401 UNIVERSITY PKWY
Second Line	:	SUITE 202
City	:	SARASOTA
State	:	FL
Zip	:	34243-2973
Country	:	US
Telephone Number	:	941-351-9995
Fax Number	:	941-351-6286

Provider Business Practice Location Address
First Line	:	2401 UNIVERSITY PKWY
Second Line	:	SUITE 202
City	:	SARASOTA
State	:	FL
Zip	:	34243-2973
Country	:	US
Telephone Number	:	941-351-9995
Fax Number	:	941-351-6286

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	07/08/2007

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