Provider Demographics
NPI:1427258524
Name:KATHLEEN STIENSTRA, MD,PC
Entity type:Organization
Organization Name:KATHLEEN STIENSTRA, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:STIENSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-235-4867
Mailing Address - Street 1:1801 N 6TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-4086
Mailing Address - Country:US
Mailing Address - Phone:812-235-4867
Mailing Address - Fax:812-232-8059
Practice Address - Street 1:1801 N 6TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4086
Practice Address - Country:US
Practice Address - Phone:812-235-4867
Practice Address - Fax:812-232-8059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038853A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232720Medicare Oscar/Certification
INB26696Medicare UPIN