Healthcare Provider Details

I. General information

NPI: 1548657067
Provider Name (Legal Business Name): PAUL R STEVENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4480 W SPENCER ST
APPLETON WI
54914-9106
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 920-738-4800
  • Fax: 920-738-5749
Mailing address:
  • Phone: 920-738-4800
  • Fax: 920-738-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number66341
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: