MEDICARE: STEPHAN M MAGILL CPO

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	222Z00000X	Orthotist
2	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1942497920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHAN M MAGILL CPO

Provider Business Mailing Address
First Line	:	295 W CROMWELL AVE
Second Line	:	SUITE 102
City	:	FRESNO
State	:	CA
Zip	:	93711-6167
Country	:	US
Telephone Number	:	559-493-5020
Fax Number	:	559-492-3569

Provider Business Practice Location Address
First Line	:	295 W CROMWELL AVE
Second Line	:	SUITE 102
City	:	FRESNO
State	:	CA
Zip	:	93711-6167
Country	:	US
Telephone Number	:	559-493-5020
Fax Number	:	559-492-3569

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

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	04/20/2015

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