Provider Demographics
NPI:1669569257
Name:MICHELLE H STEVENS MD PA
Entity type:Organization
Organization Name:MICHELLE H STEVENS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:HELENA
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-537-8555
Mailing Address - Street 1:1200 HENLEY LANE
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:FL
Mailing Address - Zip Code:32531
Mailing Address - Country:US
Mailing Address - Phone:850-537-8555
Mailing Address - Fax:850-537-8515
Practice Address - Street 1:1200 HENLEY LANE
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:FL
Practice Address - Zip Code:32531
Practice Address - Country:US
Practice Address - Phone:850-537-8555
Practice Address - Fax:850-537-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
03170OtherBCBS
279211OtherWELLCARE
H08900Medicare UPIN
03170VMedicare ID - Type Unspecified