Provider Demographics
NPI:1689853681
Name:STEPEK, MAGDALEN (DO)
Entity Type:Individual
Prefix:
First Name:MAGDALEN
Middle Name:
Last Name:STEPEK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14555 W NATIONAL AVE STE 195
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-4484
Mailing Address - Country:US
Mailing Address - Phone:262-827-3290
Mailing Address - Fax:
Practice Address - Street 1:14555 W NATIONAL AVE STE 195
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4484
Practice Address - Country:US
Practice Address - Phone:262-827-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50388-212083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00617885OtherRR MEDICARE
WI1689853681Medicaid
WIK400279031Medicare PIN
WIP00617885OtherRR MEDICARE
WI01994-0326Medicare PIN