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Organization
MAIN ST MEDICAL USA
Active
Organization
MAIN ST MEDICAL USA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN ALLEN STEFANO MD (DIRECTOR MD)
(813) 968-6000
Entity
Organization
Contact information
Practice address
11734 NORTH DALE MABRY, TAMPA, FL 33618
(813) 968-6000
(813) 968-6007
Mailing address
11734 NORTH DALE MABRY, TAMPA, FL 33618
(813) 968-6000
(813) 968-6007
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
NULL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
NULL
208VP0000X
Pain Medicine Physician
—
—
Other
Enumeration date
04/10/2007
Last updated
09/24/2013
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