Provider Demographics
NPI:1659337491
Name:KREITZER, STEPHEN MORDECAI (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MORDECAI
Last Name:KREITZER
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 1:2919 W SWANN AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4038
Mailing Address - Country:US
Mailing Address - Phone:813-877-5337
Mailing Address - Fax:813-872-0284
Practice Address - Street 1:2919 W SWANN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4038
Practice Address - Country:US
Practice Address - Phone:813-877-5337
Practice Address - Fax:813-872-0284
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0022412207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03176900Medicaid
FL290013562OtherRAILROAD MEDICARE
FL29895OtherBLUE CROSS BLUE SHIELD
FL21066038OtherAETNA
FL03176900Medicaid