Provider Demographics
NPI:1649388851
Name:STERN, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:STERN
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 2290
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-2290
Mailing Address - Country:US
Mailing Address - Phone:920-320-2840
Mailing Address - Fax:
Practice Address - Street 1:1818 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-1441
Practice Address - Country:US
Practice Address - Phone:920-320-6344
Practice Address - Fax:920-682-6768
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23260208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIW004685OtherCHAMPUS
WI110006357OtherWEA
WI3400156067OtherRAILROAD MEDICARE
WI3908063950B1OtherBLUE CROSS BLUE SHIELD
WIB56871OtherCIGNA
WI3017OtherNETWORK HEALTH PLAN
WI30352000Medicaid
WI373980001OtherDMERC
WI23260OtherTOUCHPOINT
WI3908063950B1OtherBLUE CROSS BLUE SHIELD
WI38210-0002Medicare ID - Type Unspecified