Provider Demographics
NPI:1821245242
Name:STELLA MARIS HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:STELLA MARIS HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:R
Authorized Official - Last Name:DI PIETRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-993-4400
Mailing Address - Street 1:1045 95TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2108
Mailing Address - Country:US
Mailing Address - Phone:305-993-4400
Mailing Address - Fax:305-993-4402
Practice Address - Street 1:1045 95TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2108
Practice Address - Country:US
Practice Address - Phone:305-993-4400
Practice Address - Fax:305-993-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8332AMedicare PIN