MEDICARE: MRS. AMY WAGELIE STEFFEN 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
1	174400000X	Specialist	35704	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35704	OTHER	AZ	ARIZONA MEDICAL LICENSE

General Provider Information

NPI Number	:	1467485169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY WAGELIE STEFFEN M.D.

Provider Business Mailing Address
First Line	:	2960 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1912
Country	:	US
Telephone Number	:	520-325-5701
Fax Number	:	520-325-0128

Provider Business Practice Location Address
First Line	:	2960 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1912
Country	:	US
Telephone Number	:	520-325-5701
Fax Number	:	520-325-0128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	07/08/2007

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