Provider Demographics
NPI:1184724171
Name:ZECHOWY, STEFAN M (MD)
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:M
Last Name:ZECHOWY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-575-6049
Mailing Address - Fax:707-523-3024
Practice Address - Street 1:1701 4TH ST
Practice Address - Street 2:STE 120
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3661
Practice Address - Country:US
Practice Address - Phone:707-523-7025
Practice Address - Fax:707-523-3024
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA74678207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0079030Medicaid
CAP00933205OtherRAILROAD MEDICARE
CAGR0079030Medicaid
CA00A746780Medicare PIN
CAEU977ZMedicare PIN