Provider Demographics
NPI:1649228990
Name:RABEN, STEPHEN LEO (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEO
Last Name:RABEN
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 1:9722 COMMERCE CENTER COURT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3607
Mailing Address - Country:US
Mailing Address - Phone:239-415-1111
Mailing Address - Fax:239-415-1199
Practice Address - Street 1:9722 COMMERCE CENTER COURT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3607
Practice Address - Country:US
Practice Address - Phone:239-415-1111
Practice Address - Fax:239-415-1199
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085055207Q00000X
FLME164802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085055Medicaid
IL036085055Medicaid
IL382430Medicare ID - Type Unspecified