Provider Demographics
NPI:1457360760
Name:NOTTESTAD, STEPHANIE L (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:NOTTESTAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 KATIE CT
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53523-9308
Mailing Address - Country:US
Mailing Address - Phone:608-423-1100
Mailing Address - Fax:608-423-9851
Practice Address - Street 1:704 KATIE CT
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:WI
Practice Address - Zip Code:53523-9308
Practice Address - Country:US
Practice Address - Phone:608-423-1100
Practice Address - Fax:608-423-9851
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46323-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34677000Medicaid
WI34677000Medicaid
WI150350026Medicare PIN
WII37779Medicare UPIN
WI34677000Medicaid