Healthcare Provider Details

I. General information

NPI: 1669696167
Provider Name (Legal Business Name): STEPHEN PAQUELET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E PALMER RD
BELLEFONTAINE OH
43311-2281
US

IV. Provider business mailing address

410 W 10TH AVE N416 DOAN HALL
COLUMBUS OH
43210-1240
US

V. Phone/Fax

Practice location:
  • Phone: 937-592-4015
  • Fax: 937-210-5351
Mailing address:
  • Phone: 614-293-8487
  • Fax: 614-293-8153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35.089188
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.089188
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: