Most Relevant Information
Provider Data
| NPI Number: | 1003357559 |
| Provider Name: | STEVEN LEE UNDHEIM IDC |
| Entity Type: | Individual |
| Taxonomy Code: | 1710I1002X |
| Specialty: | Military Health Care Provider |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/16/2017 |
| Last Updated: | 03/16/2017 |
Provider Practice Location
2080 CHILD ST
JACKSONVILLE
FL
322145005
Practice Location Phone/Fax
| Phone: | 9045467094 |
| Fax: |
Provider Mailing Location
2080 CHILD ST
JACKSONVILLE
FL
322145005
Provider Mailing Phone/Fax
| Phone: | 9045467094 |
| Fax: |