Healthcare Provider Details

I. General information

NPI: 1568449742
Provider Name (Legal Business Name): DAVID STERN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W MAIN ST
BELGRADE MT
59714-3847
US

IV. Provider business mailing address

10100 FOREST HILLS RD
MACHESNEY PARK IL
61115-8234
US

V. Phone/Fax

Practice location:
  • Phone: 406-388-8708
  • Fax: 406-388-8710
Mailing address:
  • Phone: 815-713-2600
  • Fax: 815-654-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0056916
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29585
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: