Basic Information
| Provider Information | |||||||||
| NPI: | 1154424174 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STERN | ||||||||
| FirstName: | LOUIS | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 W COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218415560 | ||||||||
| FaxNumber: | 4074255947 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 W COLUMBIA ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218415560 | ||||||||
| FaxNumber: | 4074255947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 11/17/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME43529 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 174400000X | ME 43529 | FL | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | ME43529 | 01 | FL | MEDICAL LICENSE | OTHER | 30842 | 01 | FL | BCBS PROVIDER ID NUMBER | OTHER | 035670100 | 05 | FL | MEDICAID |