MEDICARE: STEFAN M ZECHOWY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	A74678	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00933205	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184724171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFAN M ZECHOWY M.D.

Provider Business Mailing Address
First Line	:	3536 MENDOCINO AVE
Second Line	:	STE 200
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-3634
Country	:	US
Telephone Number	:	707-575-6049
Fax Number	:	707-523-3024

Provider Business Practice Location Address
First Line	:	1701 4TH ST
Second Line	:	STE 120
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-3661
Country	:	US
Telephone Number	:	707-523-7025
Fax Number	:	707-523-3024

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	02/07/2012

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