Provider Demographics
NPI:1194728832
Name:BADOLATO, STEPHEN K (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:K
Last Name:BADOLATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:247 LANSING ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-5102
Mailing Address - Country:US
Mailing Address - Phone:321-253-2169
Mailing Address - Fax:
Practice Address - Street 1:6300 N WICKHAM RD
Practice Address - Street 2:STE 101 -108
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2028
Practice Address - Country:US
Practice Address - Phone:321-253-2169
Practice Address - Fax:321-253-1720
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME78710207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH48987Medicare UPIN
FL01848AMedicare ID - Type Unspecified