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NPI Code Detail

MEDICARE: PAUL MICHAEL STOVER MD

MEDICARE: PAUL MICHAEL STOVER 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
1207N00000XDermatology Physician38944-020WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000817140OTHERWIMEDICARE
3P00338098OTHERWIRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
438944-020OTHERWISTATE LICENSE

General Provider Information

NPI Number : 1548264336
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL MICHAEL STOVER MD
Provider Business Mailing Address
First Line : 801 YORK ST
Second Line :
City : MANITOWOC
State : WI
Zip : 54220-4630
Country : US
Telephone Number : 920-683-5278
Fax Number : 920-686-9674
Provider Business Practice Location Address
First Line : 2806 RIVERVIEW DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54313-6717
Country : US
Telephone Number : 920-498-7546
Fax Number : 920-569-4129
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 03/07/2023

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