Healthcare Provider Details

I. General information

NPI: 1912902099
Provider Name (Legal Business Name): STEPHAN F ESELGROTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 MCCALLIE AVE
CHATTANOOGA TN
37404-3258
US

IV. Provider business mailing address

302 NORTHGATE MALL DR. # 597
HIXSON TN
37343
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-6061
  • Fax:
Mailing address:
  • Phone: 423-316-3614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberMD0000036511
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD0000036511
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number36659
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: