Healthcare Provider Details

I. General information

NPI: 1699190504
Provider Name (Legal Business Name): STEPHEN DORMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/17/2022
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3327 HOWARD AVE
STEVENS POINT WI
54481-5655
US

IV. Provider business mailing address

3327 HOWARD AVE
STEVENS POINT WI
54481-5655
US

V. Phone/Fax

Practice location:
  • Phone: 414-559-5546
  • Fax: 866-301-9533
Mailing address:
  • Phone: 414-559-5546
  • Fax: 866-301-9533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License NumberMD2013-0691
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: