Healthcare Provider Details

I. General information

NPI: 1710965157
Provider Name (Legal Business Name): STEPHAN G MUHLEBACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 YARMOUTH RD
HYANNIS MA
02601-3064
US

IV. Provider business mailing address

140 YARMOUTH RD
HYANNIS MA
02601-3064
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-8818
  • Fax: 508-778-1003
Mailing address:
  • Phone: 508-778-8818
  • Fax: 508-778-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number226058
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: