Provider Demographics
NPI:1770807489
Name:STEPHEN KREITZER MD PA
Entity type:Organization
Organization Name:STEPHEN KREITZER MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MORDECAI
Authorized Official - Last Name:KREITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-877-5337
Mailing Address - Street 1:2919 W SWANN AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4038
Mailing Address - Country:US
Mailing Address - Phone:813-877-5337
Mailing Address - Fax:813-872-0284
Practice Address - Street 1:2919 W SWANN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4038
Practice Address - Country:US
Practice Address - Phone:813-877-5337
Practice Address - Fax:813-872-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0022412207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290015002OtherRAILROAD MEDICARE
FL29895OtherBLUE CROSS/BLUE SHIELD
FL037176900Medicaid
21066038OtherAETNA
21066038OtherAETNA