Provider Demographics
NPI:1780067694
Name:STIEG, GRETCHEN (MD)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:STIEG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W COPELAND DR
Mailing Address - Street 2:1ST FL
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2101
Mailing Address - Country:US
Mailing Address - Phone:321-841-7090
Mailing Address - Fax:321-843-2267
Practice Address - Street 1:125 W COPELAND DR
Practice Address - Street 2:1ST FL
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2101
Practice Address - Country:US
Practice Address - Phone:321-841-7090
Practice Address - Fax:321-843-2267
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301502703390200000X
FLTRN21711390200000X
FLME160816208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118946300Medicaid