Provider Demographics
NPI:1811952906
Name:STEPHEN A SWITLYK MD PLLC
Entity type:Organization
Organization Name:STEPHEN A SWITLYK MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWITLYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-953-9955
Mailing Address - Street 1:1921 WALDEMERE ST
Mailing Address - Street 2:SUITE 509
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2943
Mailing Address - Country:US
Mailing Address - Phone:941-953-9955
Mailing Address - Fax:941-953-9933
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:SUITE 509
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2943
Practice Address - Country:US
Practice Address - Phone:941-953-9955
Practice Address - Fax:941-953-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDG4151OtherRR MEDICARE
FL=========OtherTAX ID
FL=========OtherTAX ID