Provider Demographics
NPI:1942249578
Name:STEIN, DAVID IRVING (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:IRVING
Last Name:STEIN
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 1:10425 W HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-1912
Mailing Address - Country:US
Mailing Address - Phone:262-238-0615
Mailing Address - Fax:414-257-4673
Practice Address - Street 1:5400 N 118TTH COURT
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225
Practice Address - Country:US
Practice Address - Phone:414-257-4673
Practice Address - Fax:414-257-4688
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
E86969Medicare UPIN