Healthcare Provider Details

I. General information

NPI: 1902836984
Provider Name (Legal Business Name): MARIA LOUISE STAMP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 W US HIGHWAY 30 STEA
VALPARAISO IN
46385-5345
US

IV. Provider business mailing address

2022 KELLE DR
CHESTERTON IN
46304-8708
US

V. Phone/Fax

Practice location:
  • Phone: 219-464-7430
  • Fax: 219-464-8014
Mailing address:
  • Phone: 219-364-3616
  • Fax: 219-364-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM8681
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00043551
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01068785A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: