Provider Demographics
NPI:1396746137
Name:PLESICH, STEPHEN MARK (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARK
Last Name:PLESICH
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 1:3921 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4711
Mailing Address - Country:US
Mailing Address - Phone:330-856-2045
Mailing Address - Fax:330-856-2077
Practice Address - Street 1:3921 E MARKET ST
Practice Address - Street 2:BLDG. III
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4711
Practice Address - Country:US
Practice Address - Phone:330-856-2045
Practice Address - Fax:330-856-2077
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE41909207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy