Provider Demographics
NPI:1003996752
Name:STEIN, STEPHEN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:STEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:303 POTRERO ST
Mailing Address - Street 2:STE 05A
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2756
Mailing Address - Country:US
Mailing Address - Phone:831-425-1385
Mailing Address - Fax:831-425-1385
Practice Address - Street 1:303 POTRERO ST
Practice Address - Street 2:STE 05A
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2756
Practice Address - Country:US
Practice Address - Phone:831-425-1385
Practice Address - Fax:831-425-1385
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG026634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G266340Medicaid
00G266340Medicare ID - Type Unspecified
A43051Medicare UPIN