MEDICARE: SUZANA STEPANEK MD

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
1	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD062765L	OTHER	PA	LICENSE NUMBER
2	MD06265L	OTHER	PA	LICENSE NUMBER

General Provider Information

NPI Number	:	1194301275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUZANA STEPANEK MD

Provider Business Mailing Address
First Line	:	210 W CHURCH ST
Second Line	:
City	:	LIGONIER
State	:	PA
Zip	:	15658-1106
Country	:	US
Telephone Number	:	724-238-5667
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 W CHURCH ST
Second Line	:
City	:	LIGONIER
State	:	PA
Zip	:	15658-1106
Country	:	US
Telephone Number	:	724-238-5667
Fax Number	:	888-364-8834

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	SUZANA STEPANEK
Credential	:	MD
Telephone Number	:	724-238-5667

Provider Enumeration Date	:	03/20/2021
Last Update Date	:	03/20/2021

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Directions to “SUZANA STEPANEK MD ” Practice Location

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