Provider Demographics
NPI:1538329578
Name:KACHALA, STEFAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:S
Last Name:KACHALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:56 FRANKLIN ST DEPARTMENT OF CARDIOTHORACIC SURG
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706
Mailing Address - Country:US
Mailing Address - Phone:203-709-6871
Mailing Address - Fax:203-759-1537
Practice Address - Street 1:56 FRANKLIN ST DEPARTMENT OF CARDIOTHORACIC SURG
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706
Practice Address - Country:US
Practice Address - Phone:203-709-6871
Practice Address - Fax:203-759-1537
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1.056125208G00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty