MEDICARE: DOUGLAS STEIN MD

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	208D00000X	General Practice Physician	123456	IL
2	208D00000X	General Practice Physician	27501	NE

General Provider Information

NPI Number	:	1588928923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS STEIN MD

Provider Business Mailing Address
First Line	:	5 S 500 W UNIT 1205
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-4127
Country	:	US
Telephone Number	:	217-721-2265
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 S 500 W UNIT 1205
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-4127
Country	:	US
Telephone Number	:	217-721-2265
Fax Number	:

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

Provider Enumeration Date	:	06/29/2012
Last Update Date	:	09/14/2019

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Directions to “ DOUGLAS STEIN MD” Practice Location

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