Provider Demographics
NPI:1093715047
Name:STIBICH, ADAM STEFAN (MD)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:STEFAN
Last Name:STIBICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 CENTRAL AVE
Mailing Address - Street 2:STE N
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6404
Mailing Address - Country:US
Mailing Address - Phone:501-623-6100
Mailing Address - Fax:501-623-6187
Practice Address - Street 1:3633 CENTRAL AVE
Practice Address - Street 2:STE N
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6404
Practice Address - Country:US
Practice Address - Phone:501-623-6100
Practice Address - Fax:501-623-6187
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2886207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143844001Medicaid
ARE2886OtherSTATE LICENSE
AR18885000000OtherQUALCHOICE
7237284OtherAETNA