Provider Demographics
NPI:1699750844
Name:SAXE, STEPHEN JOEL (MD, FACS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOEL
Last Name:SAXE
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 N ILLINOIS ST STE 1060
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1167
Mailing Address - Country:US
Mailing Address - Phone:317-817-1414
Mailing Address - Fax:317-805-4587
Practice Address - Street 1:10300 N ILLINOIS ST STE 1060
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1167
Practice Address - Country:US
Practice Address - Phone:317-817-1414
Practice Address - Fax:317-805-4587
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01079463A207W00000X, 207WX0107X
NMMD2012-0131
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4173225Medicaid
MI4173225Medicaid