Provider Demographics
NPI:1568588804
Name:STAHLE, CHRISTINE SUSANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:SUSANNE
Last Name:STAHLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:660 BEAVER CREEK CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1745
Mailing Address - Country:US
Mailing Address - Phone:419-891-6221
Mailing Address - Fax:419-893-3394
Practice Address - Street 1:660 BEAVER CREEK CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1745
Practice Address - Country:US
Practice Address - Phone:419-891-6221
Practice Address - Fax:419-893-3394
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301085739208000000X, 2080N0001X, 2080P0214X, 208M00000X, 390200000X
OH35095028208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3094351Medicaid
OH4303131Medicare PIN