Provider Demographics
NPI:1790885283
Name:DIEHLMANN, STEPHANIE DAWN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DAWN
Last Name:DIEHLMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DAWN
Other - Last Name:DOENGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1160 W BROAD ST
Mailing Address - Street 2:LOWER LIGHTS CHRISTIAN HEALTH CENTER
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222
Mailing Address - Country:US
Mailing Address - Phone:614-274-1455
Mailing Address - Fax:614-274-2040
Practice Address - Street 1:1160 W BROAD ST
Practice Address - Street 2:LOWER LIGHTS CHRISTIAN HEALTH CENTER
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222
Practice Address - Country:US
Practice Address - Phone:614-274-1455
Practice Address - Fax:614-274-2040
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH122809207Q00000X
TXL8044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine