Provider Demographics
NPI:1134278047
Name:STRIEGEL, STEPHEN PRANGE (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PRANGE
Last Name:STRIEGEL
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 1:4351 E LOHMAN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8259
Mailing Address - Country:US
Mailing Address - Phone:575-522-4940
Mailing Address - Fax:575-522-4932
Practice Address - Street 1:4351 E LOHMAN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8259
Practice Address - Country:US
Practice Address - Phone:575-522-4940
Practice Address - Fax:575-522-4932
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036080224208600000X
NMMD2016-0792208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00206150OtherRR MEDICARE
IL036080224Medicaid
ILE64557Medicare UPIN
ILP00206150OtherRR MEDICARE