Provider Demographics
NPI:1710965157
Name:MUHLEBACH, STEPHAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:G
Last Name:MUHLEBACH
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 1:140 YARMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3064
Mailing Address - Country:US
Mailing Address - Phone:508-778-8818
Mailing Address - Fax:508-778-1003
Practice Address - Street 1:140 YARMOUTH RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3064
Practice Address - Country:US
Practice Address - Phone:508-778-8818
Practice Address - Fax:508-778-1003
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226058207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ29071OtherBCBSMA
MA2109328Medicaid
MAA38965Medicare ID - Type Unspecified
MA2109328Medicaid