Healthcare Provider Details

I. General information

NPI: 1639340672
Provider Name (Legal Business Name): STEPHEN F. MITROS, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 CEDAR ST STE 160
SOUTH BEND IN
46617-2093
US

IV. Provider business mailing address

720 CEDAR ST STE 160
SOUTH BEND IN
46617-2093
US

V. Phone/Fax

Practice location:
  • Phone: 574-232-7064
  • Fax: 574-232-7136
Mailing address:
  • Phone: 574-232-7064
  • Fax: 574-232-7136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number01030913
License Number StateIN

VIII. Authorized Official

Name: DR. STEPHEN F MITROS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 574-232-7064