Provider Demographics
NPI:1609898006
Name:FIEDOREK, STEPHEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:FIEDOREK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1525 COUNTRY CLUB ROAD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5076
Mailing Address - Country:US
Mailing Address - Phone:501-758-1530
Mailing Address - Fax:501-819-6171
Practice Address - Street 1:1525 COUNTRY CLUB ROAD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5076
Practice Address - Country:US
Practice Address - Phone:501-758-1530
Practice Address - Fax:501-819-6171
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR36782080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100160440AMedicaid
AR50644OtherBLUE CROSS BLUE SHIELD
AR112344001Medicaid