Provider Demographics
NPI:1093027120
Name:STEFANI, ANDREW J (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:STEFANI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1221 PLEASANT ST
Mailing Address - Street 2:STE 200
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1423
Mailing Address - Country:US
Mailing Address - Phone:515-241-4019
Mailing Address - Fax:515-241-4051
Practice Address - Street 1:1221 PLEASANT ST
Practice Address - Street 2:STE 200
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1423
Practice Address - Country:US
Practice Address - Phone:515-241-4019
Practice Address - Fax:515-241-4051
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2015-02-11
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Provider Licenses
StateLicense IDTaxonomies
IAR9030207R00000X
IADO-04612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1093027120Medicaid
IAP01364670OtherRR MEDICARE
IA1093027120Medicaid