Provider Demographics
NPI:1639340672
Name:STEPHEN F. MITROS, M.D., P.C.
Entity Type:Organization
Organization Name:STEPHEN F. MITROS, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MITROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-232-7064
Mailing Address - Street 1:720 CEDAR ST STE 160
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2093
Mailing Address - Country:US
Mailing Address - Phone:574-232-7064
Mailing Address - Fax:574-232-7136
Practice Address - Street 1:720 CEDAR ST STE 160
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2093
Practice Address - Country:US
Practice Address - Phone:574-232-7064
Practice Address - Fax:574-232-7136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030913207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E05820Medicare UPIN
739310Medicare PIN