Healthcare Provider Details

I. General information

NPI: 1568588804
Provider Name (Legal Business Name): CHRISTINE SUSANNE STAHLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 BEAVER CREEK CIR SUITE 100
MAUMEE OH
43537-1745
US

IV. Provider business mailing address

660 BEAVER CREEK CIR SUITE 100
MAUMEE OH
43537-1745
US

V. Phone/Fax

Practice location:
  • Phone: 419-891-6221
  • Fax: 419-893-3394
Mailing address:
  • Phone: 419-891-6221
  • Fax: 419-893-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301085739
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4301085739
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number4301085739
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301085739
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301085739
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35095028
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: