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NPI Code Detail

MEDICARE: DR. STEPHAN F ESELGROTH M.D.

MEDICARE: DR. STEPHAN F ESELGROTH 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
1208100000XPhysical Medicine & Rehabilitation PhysicianMD0000036511TN
2208100000XPhysical Medicine & Rehabilitation Physician36659KY
3204C00000XSports Medicine (Neuromusculoskeletal Medicine) PhysicianMD0000036511TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4250014020OTHERTNRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MD0000036511OTHERTNTN MEDICAL LICENSE NUMBER
24051823OTHERTNBCBS ID NUMBER
336659OTHERKYKY MEDICAL LICENSE NUMBER
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912902099
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHAN F ESELGROTH M.D.
Provider Business Mailing Address
First Line : 302 NORTHGATE MALL DR.
Second Line : # 597
City : HIXSON
State : TN
Zip : 37343
Country : US
Telephone Number : 423-316-3614
Fax Number :
Provider Business Practice Location Address
First Line : 2333 MCCALLIE AVE
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37404-3258
Country : US
Telephone Number : 423-698-6061
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 12/03/2025

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