Provider Demographics
NPI:1275842197
Name:STERN, KATHLEEN SHIRLEY (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:SHIRLEY
Last Name:STERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 S RIVERSIDE DR APT 1103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-4615
Mailing Address - Country:US
Mailing Address - Phone:706-564-4308
Mailing Address - Fax:
Practice Address - Street 1:655 S RIVERSIDE DR APT 1103
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-4615
Practice Address - Country:US
Practice Address - Phone:706-564-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.087439207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology