Provider Demographics
NPI:1518063189
Name:BENGELSDORF, STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:BENGELSDORF
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:PO BOX 210172
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-0172
Mailing Address - Country:US
Mailing Address - Phone:615-595-8177
Mailing Address - Fax:615-595-8178
Practice Address - Street 1:400 SUGARTREE LN STE 200
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3073
Practice Address - Country:US
Practice Address - Phone:615-595-8177
Practice Address - Fax:615-595-8178
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37558208200000X
TNMD37558208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200858300Medicaid
IN200858300Medicaid
RE5174Medicare ID - Type Unspecified
IN941190C3Medicare Oscar/Certification