Provider Demographics
NPI:1750570792
Name:STEVEN A VISNAW DO PA
Entity type:Organization
Organization Name:STEVEN A VISNAW DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:VISNAW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-796-2494
Mailing Address - Street 1:11373 CORTEZ BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5414
Mailing Address - Country:US
Mailing Address - Phone:352-796-2494
Mailing Address - Fax:
Practice Address - Street 1:11373 CORTEZ BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5414
Practice Address - Country:US
Practice Address - Phone:352-796-2494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9556208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274271300Medicaid
FL274271300Medicaid
FLK8912Medicare PIN