Healthcare Provider Details

I. General information

NPI: 1649388851
Provider Name (Legal Business Name): JOHN M STERN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 MEMORIAL DR
MANITOWOC WI
54220-1441
US

IV. Provider business mailing address

PO BOX 2290
MANITOWOC WI
54221-2290
US

V. Phone/Fax

Practice location:
  • Phone: 920-320-6344
  • Fax: 920-682-6768
Mailing address:
  • Phone: 920-320-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number23260
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierW004685
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerCHAMPUS
# 2
Identifier110006357
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerWEA
# 3
Identifier3400156067
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerRAILROAD MEDICARE
# 4
Identifier3908063950B1
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerBLUE CROSS BLUE SHIELD
# 5
IdentifierB56871
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerCIGNA
# 6
Identifier3017
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerNETWORK HEALTH PLAN
# 7
Identifier30352000
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer
# 8
Identifier373980001
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerDMERC
# 9
Identifier23260
Identifier TypeOTHER
Identifier StateWI
Identifier IssuerTOUCHPOINT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: