Provider Demographics
NPI:1114952405
Name:DEUTSCH, STEPHEN FLOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FLOYD
Last Name:DEUTSCH
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:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:
Practice Address - Street 1:2600 GREENBUSH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2477
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-8544
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059098207RG0100X
WI35134020207RG0100X
IN01069255A207RG0100X
WI35134-020207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000708301OtherANTHEM PROVIDER NUMBER
IN201013970Medicaid
WI35371400Medicaid
WI35371400Medicaid
INM400043207Medicare PIN
INP00932668Medicare PIN
IN000000708301OtherANTHEM PROVIDER NUMBER