Provider Demographics
NPI:1326061177
Name:MAWN, STEPHEN V (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:V
Last Name:MAWN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3805B SPRING ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1641
Mailing Address - Country:US
Mailing Address - Phone:262-687-6150
Mailing Address - Fax:
Practice Address - Street 1:3805B SPRING ST
Practice Address - Street 2:SUITE 260
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-1641
Practice Address - Country:US
Practice Address - Phone:262-687-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1556742083X0100X
WI43630-0202083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H45689Medicare UPIN