Provider Demographics
NPI:1780826644
Name:CHRISTIAN, STEFANIE SCHUPP (MD)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:SCHUPP
Last Name:CHRISTIAN
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 1:660 DOVER CENTER ROAD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140
Mailing Address - Country:US
Mailing Address - Phone:216-406-7294
Mailing Address - Fax:
Practice Address - Street 1:660 DOVER CENTER RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-2370
Practice Address - Country:US
Practice Address - Phone:216-406-7294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH55860207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG34616Medicare PIN