Healthcare Provider Details

I. General information

NPI: 1326076456
Provider Name (Legal Business Name): STEPHEN R. LOHEIDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N MARR RD
COLUMBUS IN
47201-5505
US

IV. Provider business mailing address

1120 N. MARR ROAD
COLUMBUS IN
47201-5501
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-9219
  • Fax: 812-378-4821
Mailing address:
  • Phone: 812-376-9219
  • Fax: 812-378-4821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1023933
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: