Provider Demographics
NPI:1912999863
Name:STAELIN, STEPHEN TYLER (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:TYLER
Last Name:STAELIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:S.
Other - Middle Name:TYLER
Other - Last Name:STAELIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-243-8153
Mailing Address - Fax:
Practice Address - Street 1:4230 HARDING PIKE
Practice Address - Street 2:SUITE 1000
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-383-2693
Practice Address - Fax:615-292-9469
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082856208600000X, 2086S0105X
TNMD41498208600000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4560078Medicaid
TN0406260002Medicare NSC
H75089Medicare UPIN
MI4560078Medicaid
TN3816798Medicare PIN