Provider Demographics
NPI:1457356701
Name:KNEZEVICH, STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:KNEZEVICH
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 1:3820 NORTHDALE BLVD
Mailing Address - Street 2:STE 105A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1834
Mailing Address - Country:US
Mailing Address - Phone:813-960-1655
Mailing Address - Fax:813-960-3681
Practice Address - Street 1:3820 NORTHDALE BLVD
Practice Address - Street 2:STE 105A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1834
Practice Address - Country:US
Practice Address - Phone:813-960-1655
Practice Address - Fax:813-960-3681
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL593072246204C00000X, 207X00000X, 207XS0114X, 207XX0004X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593072246OtherCOMMERCIAL CARRIERS
FL12696OtherBLUE CROSS BLUE SHIELD
FLME0060554OtherWORKERS COMPENSATION
FL056274200Medicaid
FL056274200Medicaid
FL12696YMedicare PIN