Provider Demographics
NPI:1255786372
Name:ORTHOSTEM INSTITUTE, PA
Entity type:Organization
Organization Name:ORTHOSTEM INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-575-5276
Mailing Address - Street 1:2202 N WEST SHORE BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5759
Mailing Address - Country:US
Mailing Address - Phone:813-575-5276
Mailing Address - Fax:813-315-7061
Practice Address - Street 1:2202 N WEST SHORE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5759
Practice Address - Country:US
Practice Address - Phone:813-575-5276
Practice Address - Fax:813-315-7061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1619053766OtherPERSONAL NPI
FLK0368Medicare PIN