Provider Demographics
NPI:1407057045
Name:MARKO, STEPHANIE MULLIGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MULLIGAN
Last Name:MARKO
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 1:24100 CHAGRIN BLVD SUITE 130
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-359-1097
Mailing Address - Fax:888-463-9759
Practice Address - Street 1:24100 CHAGRIN BLVD SUITE 130
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-359-1097
Practice Address - Fax:888-463-9759
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-015532084P0800X
OH35.1233622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry