Provider Demographics
NPI:1750510798
Name:RACHAEL, STEPHEN T (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:T
Last Name:RACHAEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S
Other - Middle Name:TROY
Other - Last Name:RACHAEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8905
Mailing Address - Fax:352-674-8901
Practice Address - Street 1:2485 PINELLAS PL
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2703
Practice Address - Country:US
Practice Address - Phone:844-884-9355
Practice Address - Fax:352-674-8920
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46904207Q00000X
FLME170152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013890Medicaid
TNQ013890Medicaid