Healthcare Provider Details

I. General information

NPI: 1881687192
Provider Name (Legal Business Name): GEORGE CAJETAN STEPANIC JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 INDEPENDENCE WAY STE 150
CLYDE OH
43410-9812
US

IV. Provider business mailing address

PO BOX 378
SANDUSKY OH
44871-0378
US

V. Phone/Fax

Practice location:
  • Phone: 419-547-2810
  • Fax: 419-547-1301
Mailing address:
  • Phone: 419-609-1112
  • Fax: 419-609-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34006552
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: