Provider Demographics
NPI:1487658803
Name:PAPENFUSS, STEPHEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:PAPENFUSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 FARNAM ST
Mailing Address - Street 2:STE 360
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2850
Mailing Address - Country:US
Mailing Address - Phone:402-552-2555
Mailing Address - Fax:402-552-2573
Practice Address - Street 1:4242 FARNAM ST
Practice Address - Street 2:STE 360
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2850
Practice Address - Country:US
Practice Address - Phone:402-552-2555
Practice Address - Fax:402-552-2573
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13126207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47062325613Medicaid
PA501880OtherBLUE SHIELD
IA0942417Medicaid
NE0001967OtherBLUE SHIELD
IA94241OtherBLUE SHIELD
SD7786450Medicaid
NE02769OtherBLUE SHIELD
NE0300004OtherUNITED HEALTH CARE
KSPA501592Medicaid
IA94241OtherBLUE SHIELD
SD7786450Medicaid