Provider Demographics
NPI:1093808149
Name:STEGEMOLLER, RONALD (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:STEGEMOLLER
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 1:5250 E US HIGHWAY 36
Mailing Address - Street 2:SUITE 610
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9199
Mailing Address - Country:US
Mailing Address - Phone:317-745-5403
Mailing Address - Fax:
Practice Address - Street 1:5250 E US HIGHWAY 36
Practice Address - Street 2:SUITE 610
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9199
Practice Address - Country:US
Practice Address - Phone:317-745-5403
Practice Address - Fax:317-718-2180
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100133220Medicaid
IN100133220Medicaid
IN151560A1Medicare PIN
IN100133220Medicaid
080158680Medicare PIN