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NPI Code Detail

MEDICARE: ERSIE POUAGARE STEVENS M.D.

MEDICARE: ERSIE POUAGARE STEVENS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician35.124403OH

General Provider Information

NPI Number : 1063714004
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERSIE POUAGARE STEVENS M.D.
Provider Business Mailing Address
First Line : 3535 SOUTHERN BLVD
Second Line :
City : KETTERING
State : OH
Zip : 45429-1221
Country : US
Telephone Number : 937-395-8849
Fax Number :
Provider Business Practice Location Address
First Line : 3535 SOUTHERN BLVD
Second Line :
City : KETTERING
State : OH
Zip : 45429-1221
Country : US
Telephone Number : 937-395-8849
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2010
Last Update Date : 02/09/2026

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