Provider Demographics
NPI:1407008964
Name:STEPHANIE BERGSTEIN MD, LLC
Entity Type:Organization
Organization Name:STEPHANIE BERGSTEIN MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BERGSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-844-5351
Mailing Address - Street 1:12065 OLD MERIDIAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8773
Mailing Address - Country:US
Mailing Address - Phone:317-844-5351
Mailing Address - Fax:317-844-0310
Practice Address - Street 1:12065 OLD MERIDIAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8773
Practice Address - Country:US
Practice Address - Phone:317-844-5351
Practice Address - Fax:317-844-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042405A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty