Provider Demographics
NPI:1093707267
Name:SOLLOT, STEPHEN (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:SOLLOT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5117
Mailing Address - Country:US
Mailing Address - Phone:941-497-4303
Mailing Address - Fax:941-497-3107
Practice Address - Street 1:4315 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5117
Practice Address - Country:US
Practice Address - Phone:941-497-4303
Practice Address - Fax:941-497-3107
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56716OtherBCBS
FL56716AOtherMEDICARE PTAN
FLP00614918OtherRAILROAD MEDICARE
FL254050900Medicaid
FL080182478OtherMEDICARE RR
FL56716ZMedicare PIN
FL254050900Medicaid