Provider Demographics
NPI:1164498192
Name:CHENG, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:CHENG
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 1:1325 PENNSYLVANIA AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2191
Mailing Address - Country:US
Mailing Address - Phone:817-250-7240
Mailing Address - Fax:888-977-1985
Practice Address - Street 1:1325 PENNSYLVANIA AVE STE 450
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2191
Practice Address - Country:US
Practice Address - Phone:817-250-7240
Practice Address - Fax:888-977-1985
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5701204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H8674OtherBC/BS
TX158196902Medicaid
TX158196902Medicaid
TX8G8779Medicare PIN