Provider Demographics
NPI:1588726970
Name:STELLMACHER, STEPHAN (DO-FACP)
Entity type:Individual
Prefix:
First Name:STEPHAN
Middle Name:
Last Name:STELLMACHER
Suffix:
Gender:M
Credentials:DO-FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2277
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-2277
Mailing Address - Country:US
Mailing Address - Phone:928-556-0060
Mailing Address - Fax:928-556-0015
Practice Address - Street 1:3150 N WINDING BROOK RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-0972
Practice Address - Country:US
Practice Address - Phone:928-556-0060
Practice Address - Fax:928-556-0015
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ109290Medicaid
Z121962Medicare PIN
AZF61087Medicare UPIN
AZ109290Medicaid