Provider Demographics
NPI:1619957230
Name:MERFELD, STEPHEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:MERFELD
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:PO BOX 2723
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54903-2723
Mailing Address - Country:US
Mailing Address - Phone:920-232-6550
Mailing Address - Fax:920-232-6552
Practice Address - Street 1:1885 W POINTE DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-4174
Practice Address - Country:US
Practice Address - Phone:920-232-6550
Practice Address - Fax:920-232-6552
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34248207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31935900Medicaid
WI31935900Medicaid
WI69015-0001Medicare ID - Type Unspecified
180030834Medicare PIN
180036444Medicare PIN
WI71490-0001Medicare ID - Type Unspecified
WIF48737Medicare UPIN
WI26020-0001Medicare ID - Type Unspecified