Provider Demographics
NPI:1952507170
Name:NIGHTINGALE, STEPHEN DINSMOOR (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DINSMOOR
Last Name:NIGHTINGALE
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 1:5838 W BRICK RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-8420
Mailing Address - Country:US
Mailing Address - Phone:574-247-1911
Mailing Address - Fax:574-247-1912
Practice Address - Street 1:5838 W BRICK RD STE 106
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-8420
Practice Address - Country:US
Practice Address - Phone:574-247-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD15904207R00000X
TXH3129207R00000X
IL036-059866207R00000X
IN01074832A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine