Provider Demographics
NPI:1295703635
Name:WERNER, STEPHEN J (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:WERNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2920 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-1944
Mailing Address - Country:US
Mailing Address - Phone:920-496-4700
Mailing Address - Fax:920-458-3163
Practice Address - Street 1:2920 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1944
Practice Address - Country:US
Practice Address - Phone:920-496-4700
Practice Address - Fax:920-458-3163
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2015-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI28120208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30766200Medicaid
WI30766200Medicaid
WIB57565Medicare UPIN