Provider Demographics
NPI:1811955362
Name:NIMBARGI, STEPHEN PHILIP (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PHILIP
Last Name:NIMBARGI
Suffix:
Gender:M
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:PO BOX 150038
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32715-0038
Mailing Address - Country:US
Mailing Address - Phone:407-782-3702
Mailing Address - Fax:407-331-6953
Practice Address - Street 1:321 MAITLAND AVE STE 1000
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5449
Practice Address - Country:US
Practice Address - Phone:407-331-6236
Practice Address - Fax:407-331-6953
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85807208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5324701OtherAETNA
FL265742200Medicaid
FL8665410OtherCIGNA
FL204678439OtherHUMANA
FL265742201Medicaid
FL1852839OtherUNITED HEALTH CARE
FL62948OtherBLUE CROSS BLUE SHIELD
FL1852839OtherUNITED HEALTH CARE
FL204678439OtherHUMANA