Provider Demographics
NPI:1063435659
Name:UEBELE, STACY A (DPM)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:A
Last Name:UEBELE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 362
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058
Mailing Address - Country:US
Mailing Address - Phone:269-948-9155
Mailing Address - Fax:269-948-8964
Practice Address - Street 1:1005 W GREEN ST
Practice Address - Street 2:304
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1712
Practice Address - Country:US
Practice Address - Phone:269-948-9155
Practice Address - Fax:269-948-9577
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001970213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4766591Medicaid
MI4710219Medicaid
MI4710193Medicaid
U86206Medicare UPIN
P02180001Medicare ID - Type Unspecified