Provider Demographics
NPI:1134134612
Name:STEDJE, KURT (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:STEDJE
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 1:1563 E DOROTHY LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3897
Mailing Address - Country:US
Mailing Address - Phone:937-296-0253
Mailing Address - Fax:907-293-3183
Practice Address - Street 1:2222 PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1813
Practice Address - Country:US
Practice Address - Phone:937-276-7623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350707112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00064514OtherRAILROAD MEDICARE
OH0355664Medicaid
OHCK1297OtherMEDICARE RAILROAD
OH0355664Medicaid
OHP00064514OtherRAILROAD MEDICARE
0813447Medicare PIN
0813448Medicare PIN
OH0813445Medicare PIN