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NPI Code Detail

MEDICARE: MR. STEPHEN JOHN VANWYLEN M.D.

MEDICARE: MR. STEPHEN JOHN VANWYLEN 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
1208600000XSurgery Physician43010402855MI
2208600000XSurgery Physician8806ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2020G010060OTHERMIBLUE CROSS BLUE SHIELD MI
3382809956OTHERCOMMERCIAL
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437115565
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STEPHEN JOHN VANWYLEN M.D.
Provider Business Mailing Address
First Line : 709 4TH AVE NE
Second Line :
City : WATFORD CITY
State : ND
Zip : 58854-7628
Country : US
Telephone Number : 701-842-3771
Fax Number : 701-842-4025
Provider Business Practice Location Address
First Line : 709 4TH AVE NE
Second Line :
City : WATFORD CITY
State : ND
Zip : 58854-7628
Country : US
Telephone Number : 701-842-3771
Fax Number : 701-842-4025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 10/18/2024

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