Healthcare Provider Details

I. General information

NPI: 1780826644
Provider Name (Legal Business Name): STEFANIE SCHUPP CHRISTIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 DOVER CENTER RD SUITE 2A
BAY VILLAGE OH
44140-2370
US

IV. Provider business mailing address

660 DOVER CENTER ROAD SUITE 2A
BAY VILLAGE OH
44140
US

V. Phone/Fax

Practice location:
  • Phone: 216-406-7294
  • Fax:
Mailing address:
  • Phone: 216-406-7294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number55860
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: