Provider Demographics
NPI:1376555839
Name:STINE, STEPHEN B (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:B
Last Name:STINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:3200 WESTHILL DR STE 210
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4707
Mailing Address - Country:US
Mailing Address - Phone:715-847-2020
Mailing Address - Fax:715-847-0020
Practice Address - Street 1:3200 WESTHILL DR STE 210
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4707
Practice Address - Country:US
Practice Address - Phone:715-847-2020
Practice Address - Fax:715-847-0020
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI406992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32665300Medicaid
WIG73855Medicare UPIN