Healthcare Provider Details

I. General information

NPI: 1558308429
Provider Name (Legal Business Name): STEPHEN MICHAEL SPELTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 DELMORE DR
ROSEAU MN
56751-1534
US

IV. Provider business mailing address

1304 E TROY RD
WAUSAU WI
54403-2017
US

V. Phone/Fax

Practice location:
  • Phone: 218-463-2500
  • Fax:
Mailing address:
  • Phone: 715-675-6481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number44488
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number21856-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: