Provider Demographics
NPI:1790849123
Name:HAUDRICH, STEPHEN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JAMES
Last Name:HAUDRICH
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 1:3215 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5208
Mailing Address - Country:US
Mailing Address - Phone:402-420-0448
Mailing Address - Fax:
Practice Address - Street 1:4900 N 26TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4746
Practice Address - Country:US
Practice Address - Phone:402-465-0010
Practice Address - Fax:402-465-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19347207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine