Organization
WINTER HAVEN DERMATOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPAN OLIVA MD (OWNER)
(863) 299-3376
Entity
Organization
Contact information
Practice address
560 AVENUE K SE, WINTER HAVEN, FL 33880-4203
(863) 299-3376
Mailing address
560 AVENUE K SE, WINTER HAVEN, FL 33880-4203
(863) 299-3376
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME75639
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DF8589
RAILROAD MEDICARE
FL
Enumeration date
05/23/2007
Last updated
05/14/2008
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