Provider Demographics
NPI:1962494971
Name:STIENECKER, ROGER SCOTT (MD FACP FSHEA)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:SCOTT
Last Name:STIENECKER
Suffix:
Gender:M
Credentials:MD FACP FSHEA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2231 CAREW ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4713
Practice Address - Country:US
Practice Address - Phone:260-373-9935
Practice Address - Fax:260-373-9926
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066788S207RI0200X
IN01070327A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01039781OtherRR MEDICARE
OH0976421Medicaid
IN201040910Medicaid
IN000000739208OtherANTHEM
IN201040910Medicaid
INP01039781OtherRR MEDICARE
OH0976421Medicaid