Provider Demographics
NPI:1881687192
Name:STEPANIC, GEORGE CAJETAN JR (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:CAJETAN
Last Name:STEPANIC
Suffix:JR
Gender:M
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:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-609-1112
Mailing Address - Fax:419-609-1123
Practice Address - Street 1:112 INDEPENDENCE WAY STE 150
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:OH
Practice Address - Zip Code:43410-9812
Practice Address - Country:US
Practice Address - Phone:419-547-2810
Practice Address - Fax:419-547-1301
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006552207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0309526Medicaid
OH000000340454OtherBC/BS
OH396665572005OtherANTHEM
OH0309526Medicaid
OH000000340454OtherBC/BS