Provider Demographics
NPI:1427670082
Name:STEM, KODIE WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:KODIE
Middle Name:WILLIAM
Last Name:STEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:10 MUDDY CREEK FORKS RD STE 3
Practice Address - Street 2:
Practice Address - City:BROGUE
Practice Address - State:PA
Practice Address - Zip Code:17309-9497
Practice Address - Country:US
Practice Address - Phone:717-812-5020
Practice Address - Fax:717-461-7144
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-17
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD482462207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty