Provider Demographics
NPI:1972543395
Name:PENNAL, STEPHEN HUGH (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HUGH
Last Name:PENNAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4212 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2413
Mailing Address - Country:US
Mailing Address - Phone:317-443-3081
Mailing Address - Fax:888-392-3210
Practice Address - Street 1:5150 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-2601
Practice Address - Country:US
Practice Address - Phone:317-782-1577
Practice Address - Fax:888-392-3210
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01033010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB28722Medicare UPIN