Provider Demographics
NPI:1982137014
Name:DIGIANDOMENICO, STEFANIE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:
Last Name:DIGIANDOMENICO
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 1:999 N 92ND ST
Mailing Address - Street 2:SUITE 730
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4875
Mailing Address - Country:US
Mailing Address - Phone:414-337-7030
Mailing Address - Fax:414-337-7068
Practice Address - Street 1:999 N 92ND ST
Practice Address - Street 2:SUITE 730
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4875
Practice Address - Country:US
Practice Address - Phone:414-337-7030
Practice Address - Fax:414-337-7068
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI70536208000000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program