Provider Demographics
NPI:1912127408
Name:WINBLAD, STEVIE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:STEVIE
Middle Name:MARIE
Last Name:WINBLAD
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 1:641 N SENECA ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-8208
Mailing Address - Country:US
Mailing Address - Phone:316-755-1511
Mailing Address - Fax:316-755-1991
Practice Address - Street 1:641 N SENECA ST
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67147-8208
Practice Address - Country:US
Practice Address - Phone:316-755-1511
Practice Address - Fax:316-755-1991
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS04-34414207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program