MEDICARE: STEPHAN MANCE

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	363AM0700X	Medical Physician Assistant	7934	WI
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1629701081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHAN MANCE

Provider Business Mailing Address
First Line	:	7974 UW HEALTH CT
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-5531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 HIGHLAND AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53792-2434
Country	:	US
Telephone Number	:	608-262-2398
Fax Number	:

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

Provider Enumeration Date	:	07/05/2022
Last Update Date	:	12/18/2024

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Directions to “ STEPHAN MANCE ” Practice Location

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