Provider Demographics
NPI:1629294244
Name:BIFULCO, SANTO STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:SANTO
Middle Name:STEVEN
Last Name:BIFULCO
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 1:700 S HARBOUR ISLAND BLVD UNIT 339
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5770
Mailing Address - Country:US
Mailing Address - Phone:813-417-7447
Mailing Address - Fax:
Practice Address - Street 1:701 W FLETCHER AVE STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3430
Practice Address - Country:US
Practice Address - Phone:813-417-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056868208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation