Provider Demographics
NPI:1871006106
Name:SPP D.O., LLC
Entity Type:Organization
Organization Name:SPP D.O., LLC
Other - Org Name:DR. STEVEN PORTO, DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PORTO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-650-9436
Mailing Address - Street 1:9489 EDGESTONE DR APT 312
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-5342
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9660 E 146TH ST STE 100
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060
Practice Address - Country:US
Practice Address - Phone:317-774-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300013956Medicaid