MEDICARE: DR. TUESDAE STAINBROOK D.O.

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	207RI0200X	Infectious Disease Physician	OS-009811-L	PA

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	:	1588670285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TUESDAE STAINBROOK D.O.

Provider Business Mailing Address
First Line	:	135 MIDWAY DR STE B
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-3857
Country	:	US
Telephone Number	:	814-371-2348
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 MIDWAY DR STE B
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-3857
Country	:	US
Telephone Number	:	814-371-2348
Fax Number	:

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	01/15/2018

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