Provider Demographics
NPI:1114911088
Name:STEFAN, MIHAELA S (MD)
Entity type:Individual
Prefix:DR
First Name:MIHAELA
Middle Name:S
Last Name:STEFAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3229
Mailing Address - Country:US
Mailing Address - Phone:516-581-3013
Mailing Address - Fax:
Practice Address - Street 1:2735 5TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3229
Practice Address - Country:US
Practice Address - Phone:516-581-3013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223648207R00000X, 208M00000X
CODR.0074949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110040687AMedicaid
I19414Medicare UPIN
MAI19414Medicare UPIN
MAA38318Medicare PIN