Healthcare Provider Details

I. General information

NPI: 1962406983
Provider Name (Legal Business Name): JEFFREY J STEPHANY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W RIVER WOODS PARKWAY STE 130
GLENDALE WI
53212
US

IV. Provider business mailing address

575 W RIVER WOODS PKWY STE 100
GLENDALE WI
53212-1058
US

V. Phone/Fax

Practice location:
  • Phone: 414-961-0304
  • Fax: 414-961-2061
Mailing address:
  • Phone: 414-332-6262
  • Fax: 414-332-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number38539
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number38539-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: