Healthcare Provider Details

I. General information

NPI: 1871534057
Provider Name (Legal Business Name): STEPHEN JEPSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4439 STATE ROUTE 159 SUITE 130
CHILLICOTHEE OH
45601-8207
US

IV. Provider business mailing address

272 HOSPITAL RD
CHILLICOTHEE OH
45601-9031
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4360
  • Fax:
Mailing address:
  • Phone: 740-779-4360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35.065495
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: