Provider Demographics
NPI:1598758799
Name:FISCHER, STEPHEN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EDWARD
Last Name:FISCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-322-3439
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:1400 N US HIGHWAY 441 STE 912
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6811
Practice Address - Country:US
Practice Address - Phone:352-750-1277
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060280207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058382100Medicaid
FLE80454Medicare UPIN
FL14304ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER