Provider Demographics
NPI:1073508123
Name:MECKSTROTH, STEVEN ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ARTHUR
Last Name:MECKSTROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1656 MEDICAL BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1423
Mailing Address - Country:US
Mailing Address - Phone:239-593-6201
Mailing Address - Fax:239-593-6207
Practice Address - Street 1:1656 MEDICAL BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1423
Practice Address - Country:US
Practice Address - Phone:239-593-6201
Practice Address - Fax:239-593-6207
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54663207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370714800Medicaid
FL15027OtherBC FL
FLF27111Medicare UPIN
FL15027XMedicare ID - Type Unspecified