Provider Demographics
NPI:1669423331
Name:HANDLER, STEPHEN J (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:HANDLER
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 1:10001 W INNOVATION DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4851
Mailing Address - Country:US
Mailing Address - Phone:888-938-3838
Mailing Address - Fax:888-919-1083
Practice Address - Street 1:4365 PHEASANT RIDGE DR NE STE 106
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-4544
Practice Address - Country:US
Practice Address - Phone:888-938-3838
Practice Address - Fax:888-919-1083
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG251162085R0202X
HIMD93652085R0202X
WI41722-202085R0202X
FLME1033282085R0202X
MN11642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1669423331Medicaid
FLME103328Medicaid
HIMD9365Medicaid
CA00G251160OtherBLUE SHIELD OF CA
CA00G251160Medicaid
KY7100069600Medicaid
CA00G251164Medicare PIN
CA00G251162Medicare PIN
CA00G251160Medicare PIN
CA00G251166Medicare PIN
MI1669423331Medicaid
HIBF402YMedicare PIN
A42534Medicare UPIN
CA00G251160Medicaid
ID808272100Medicaid