Provider Demographics
NPI:1477944361
Name:SPAGO MEDISPA LLC
Entity Type:Organization
Organization Name:SPAGO MEDISPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:STAMPAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-505-0888
Mailing Address - Street 1:201 W MARION AVE UNIT 1314
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4467
Mailing Address - Country:US
Mailing Address - Phone:941-505-0888
Mailing Address - Fax:941-505-0890
Practice Address - Street 1:201 W MARION AVE UNIT 1314
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4467
Practice Address - Country:US
Practice Address - Phone:941-505-0888
Practice Address - Fax:941-505-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty