Individual
STEPHANIE K HISKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
206 2ND ST E, BRADENTON, FL 34208-1042
(863) 688-2334
Mailing address
2125 CRYSTAL GROVE DR, LAKELAND, FL 33801-6875
(863) 688-2334
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME78061
FL
2085R0204X
Vascular & Interventional Radiology Physician
ME78061
FL
Other
Enumeration date
05/17/2006
Last updated
04/24/2018
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