Provider Demographics
NPI:1598835209
Name:DANNEWITZ, STEPHEN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RICHARD
Last Name:DANNEWITZ
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 1:5041 ALABAMA ST
Mailing Address - Street 2:#151
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79930-2633
Mailing Address - Country:US
Mailing Address - Phone:915-566-5884
Mailing Address - Fax:915-566-5884
Practice Address - Street 1:5041 ALABAMA
Practice Address - Street 2:#151
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79930-2633
Practice Address - Country:US
Practice Address - Phone:915-566-5884
Practice Address - Fax:915-566-5884
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN233233207P00000X
IL036-061324207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN310372200Medicaid
PA312633Medicaid
MN310372200Medicaid
IL$$$$$$$$$Medicaid
ILK37308Medicare PIN
A94682Medicare UPIN
ILK45652Medicare PIN
PA312633Medicaid
MND58311Medicare ID - Type Unspecified