Provider Demographics
NPI:1588993398
Name:MICHAEL W. STEPPIE, MD, PA
Entity type:Organization
Organization Name:MICHAEL W. STEPPIE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:STEPPIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-676-3411
Mailing Address - Street 1:1109 BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4333
Mailing Address - Country:US
Mailing Address - Phone:863-676-3411
Mailing Address - Fax:863-676-1015
Practice Address - Street 1:1109 BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4333
Practice Address - Country:US
Practice Address - Phone:863-676-3411
Practice Address - Fax:863-676-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88443174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82319ZMedicare PIN
FLH63963Medicare UPIN