Provider Demographics
NPI:1427141993
Name:PORTMAN, STEVEN MYLES (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MYLES
Last Name:PORTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 LAKE OSPREY DRIVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8436
Mailing Address - Country:US
Mailing Address - Phone:941-355-0077
Mailing Address - Fax:941-907-3476
Practice Address - Street 1:6151 LAKE OSPREY DRIVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8436
Practice Address - Country:US
Practice Address - Phone:941-355-0077
Practice Address - Fax:941-907-3476
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 944212084N0402X
FLME944212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275318900Medicaid
145813Medicare ID - Type Unspecified
FL275318900Medicaid