Provider Demographics
NPI:1134135965
Name:SAM STIEGLITZ MDPA
Entity Type:Organization
Organization Name:SAM STIEGLITZ MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STIEGLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-461-4600
Mailing Address - Street 1:1305 SOUTH FORT HARRISON AVE
Mailing Address - Street 2:BLDG A
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3301
Mailing Address - Country:US
Mailing Address - Phone:727-461-4600
Mailing Address - Fax:727-461-7330
Practice Address - Street 1:1305 SOUTH FORT HARRISON AVE
Practice Address - Street 2:BLDG A
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3301
Practice Address - Country:US
Practice Address - Phone:727-461-4600
Practice Address - Fax:727-461-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33707207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E12161Medicare UPIN
FL62166Medicare PIN