Provider Demographics
NPI:1255969325
Name:OHNMACHT, STEVEN TYLER (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:TYLER
Last Name:OHNMACHT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 N WILMOT RD UNIT P181
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4480
Mailing Address - Country:US
Mailing Address - Phone:480-313-2454
Mailing Address - Fax:
Practice Address - Street 1:MSC 10-5550 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-4661
Practice Address - Fax:505-272-4628
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program