Provider Demographics
NPI:1134205875
Name:STETTLER, BRIAN ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ARTHUR
Last Name:STETTLER
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:PO BOX 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5505
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:231 ALBERT SABIN WAY
Practice Address - Street 2:ML0769
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267
Practice Address - Country:US
Practice Address - Phone:513-558-8084
Practice Address - Fax:513-281-4545
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-081666207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2501797Medicaid
OH2501797Medicaid
OHST4137811Medicare ID - Type Unspecified