Provider Demographics
NPI:1619679032
Name:PIENKOWSKI, STEFAN MATHEW (MD)
Entity Type:Individual
Prefix:
First Name:STEFAN
Middle Name:MATHEW
Last Name:PIENKOWSKI
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 1:510 RECOVERY RD STE 257
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4874
Mailing Address - Country:US
Mailing Address - Phone:615-781-4430
Mailing Address - Fax:
Practice Address - Street 1:510 RECOVERY RD STE 257
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4874
Practice Address - Country:US
Practice Address - Phone:615-781-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program