Provider Demographics
NPI:1326134933
Name:MITROS, STEPHEN FRANCES (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FRANCES
Last Name:MITROS
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 1:720 E CEDAR STREET SUITE 160
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617
Mailing Address - Country:US
Mailing Address - Phone:574-232-7064
Mailing Address - Fax:574-232-7136
Practice Address - Street 1:720 E CEDAR STREET SUITE 160
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617
Practice Address - Country:US
Practice Address - Phone:574-232-7064
Practice Address - Fax:574-232-7136
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030913207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100223830AMedicaid
IN000000085608OtherANTHEM
IN100223830AMedicaid
IN739310AMedicare PIN