Provider Demographics
NPI:1568441798
Name:STIERWALT, HOWARD G (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:G
Last Name:STIERWALT
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 1:2575 HAYES AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-5201
Mailing Address - Country:US
Mailing Address - Phone:419-332-7371
Mailing Address - Fax:419-332-7989
Practice Address - Street 1:2575 HAYES AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-5201
Practice Address - Country:US
Practice Address - Phone:419-332-7371
Practice Address - Fax:419-332-7989
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-042297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0431152Medicaid
OHST0473661Medicare ID - Type Unspecified
OH0473661Medicare PIN
OHA79269Medicare UPIN