1144286428 NPI number — KEITH B STOLTE MD

Table of content: KEITH B STOLTE MD (NPI 1144286428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144286428 NPI number — KEITH B STOLTE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOLTE
Provider First Name:
KEITH
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144286428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10441 QUALITY DR.
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-666-9990
Provider Business Mailing Address Fax Number:
352-666-1905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10441 QUALITY DR.
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
SPRING HILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-666-9990
Provider Business Practice Location Address Fax Number:
352-666-1905
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  ME43218 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12218 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00144328 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com