Provider Demographics
NPI:1255367124
Name:STOLTZFUS, WINFRED E (MD)
Entity type:Individual
Prefix:
First Name:WINFRED
Middle Name:E
Last Name:STOLTZFUS
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 1:110 DOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2231 TIMBER TRL
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9036
Practice Address - Country:US
Practice Address - Phone:937-599-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
341407259037OtherMEDICAL MUTUAL
110209314OtherRR MEDICARE
7755544OtherAETNA
OH0922578Medicaid
341407259OtherCIGNA
ST7264531OtherTRICARE
000000026809OtherANTHEM
341407259OtherNATIONWIDE
87726OtherUHC
341407259OtherNATIONWIDE
C98119Medicare UPIN