Basic Information
| Provider Information | |||||||||
| NPI: | 1902879158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FALKOWSKI | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326933239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524632374 | ||||||||
| FaxNumber: | 3524632726 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WILLISTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326961705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525280587 | ||||||||
| FaxNumber: | 3524632726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 09/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | OS11123 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 002889900 | 05 | FL | MEDICAID | EBO33Z | 01 | FL | MEDICARE PTAN | OTHER |