Healthcare Provider Details

I. General information

NPI: 1912902131
Provider Name (Legal Business Name): STEVEN LOUIS BILLIGMEIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 W MARCH LN STE 1
STOCKTON CA
95207-5723
US

IV. Provider business mailing address

89 W MARCH LN STE 1
STOCKTON CA
95207-5723
US

V. Phone/Fax

Practice location:
  • Phone: 209-478-2622
  • Fax:
Mailing address:
  • Phone: 209-478-2622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG079415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: