Provider Demographics
NPI:1679540538
Name:WADE, STEPHANIE SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUZANNE
Last Name:WADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:SUZANNE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1850N CENTRAL AVE 1600
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-4633
Mailing Address - Country:US
Mailing Address - Phone:602-262-8900
Mailing Address - Fax:602-262-8890
Practice Address - Street 1:1850 N CENTRAL AVE
Practice Address - Street 2:STE1600
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-4527
Practice Address - Country:US
Practice Address - Phone:602-744-4765
Practice Address - Fax:602-744-4799
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32619207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ874835Medicaid
P00141152OtherMEDICARE RAILROAD
P00141152OtherMEDICARE RAILROAD
AZZ82898Medicare PIN