Provider Demographics
NPI:1558717785
Name:STEFANOWICZ, MICHAEL CHRISTOPHER (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:STEFANOWICZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 N IH 35
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3401
Mailing Address - Country:US
Mailing Address - Phone:512-978-9100
Mailing Address - Fax:
Practice Address - Street 1:4614 N IH 35
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-3401
Practice Address - Country:US
Practice Address - Phone:512-978-9100
Practice Address - Fax:512-901-9751
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine