Healthcare Provider Details

I. General information

NPI: 1992924724
Provider Name (Legal Business Name): ELIZABETH STUEBING MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONE STE L119
LEXINGTON KY
40536-1647
US

IV. Provider business mailing address

1717 SHAFFER ST STE 2
KALAMAZOO MI
49048-1623
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-3253
  • Fax: 859-323-1203
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD60299596
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLP00200
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberEMC000676
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD60299596
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number59200
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: