Provider Demographics
NPI:1093198608
Name:MAGER, STEPHANIE PIVIK (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:PIVIK
Last Name:MAGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 MAIN ST STE 150
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-5561
Mailing Address - Country:US
Mailing Address - Phone:970-674-6460
Mailing Address - Fax:970-336-1505
Practice Address - Street 1:1455 MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-5561
Practice Address - Country:US
Practice Address - Phone:970-674-6460
Practice Address - Fax:970-336-1505
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301108204207V00000X
CODR.0063012207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology