Healthcare Provider Details

I. General information

NPI: 1346565371
Provider Name (Legal Business Name): STEPHANIE MARIE STAHL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE MARIE TIEKEN

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 N SENATE AVE SUITE 120
INDIANAPOLIS IN
46202-3763
US

IV. Provider business mailing address

714 N SENATE AVE STE 120
INDIANAPOLIS IN
46202-3297
US

V. Phone/Fax

Practice location:
  • Phone: 812-499-0014
  • Fax:
Mailing address:
  • Phone: 317-963-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01073636A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number01073636A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: