MEDICARE: STEFAN A DUPONT 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	2084N0400X	Neurology Physician	35-094899	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9338635	OTHER	OH	PARTNERS PHYSICIAN GROUP MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1841239274	OTHER	OH	PARTNERS PHYSICIAN GROUP TYPE 2 NPI #

General Provider Information

NPI Number	:	1609849512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEFAN A DUPONT M.D.

Provider Business Mailing Address
First Line	:	20800 HARVARD RD
Second Line	:	2ND FLR
City	:	HIGHLAND HILLS
State	:	OH
Zip	:	44122-7251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3909 ORANGE PL
Second Line	:	STE 2300
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-4478
Country	:	US
Telephone Number	:	216-285-5041
Fax Number	:

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	10/11/2016

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Directions to “ STEFAN A DUPONT M.D.” Practice Location

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