Provider Demographics
NPI:1326047903
Name:MIELECH, STEPHEN F (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:F
Last Name:MIELECH
Suffix:
Gender:M
Credentials:DPM
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 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-212-0175
Mailing Address - Fax:859-746-7464
Practice Address - Street 1:525 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:KY
Practice Address - Zip Code:41071
Practice Address - Country:US
Practice Address - Phone:859-441-4334
Practice Address - Fax:859-441-3698
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00265213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY27-01283OtherUHC
KY80000300Medicaid
KY2811377OtherAETNA
KY000000225857OtherANTHEM
KY6464Medicare PIN
KY0390103Medicare PIN
KY2011105Medicare PIN
KY2811377OtherAETNA
KY2011205Medicare PIN
KY8423Medicare PIN
KYK017811Medicare PIN
KY000000225857OtherANTHEM
KY27-01283OtherUHC