MEDICARE: DR. STEPHANIE YVONNE SUBLETT 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	207V00000X	Obstetrics & Gynecology Physician	64534-20	WI

General Provider Information

NPI Number	:	1841555380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE YVONNE SUBLETT M.D.

Provider Business Mailing Address
First Line	:	9941 ILLINOIS RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-5769
Country	:	US
Telephone Number	:	260-264-0384
Fax Number	:	260-264-2248

Provider Business Practice Location Address
First Line	:	9941 ILLINOIS RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-5769
Country	:	US
Telephone Number	:	260-264-0384
Fax Number	:	260-264-2248

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

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	03/09/2026

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