Provider Demographics
NPI:1962406983
Name:STEPHANY, JEFFREY J (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:STEPHANY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:575 W RIVER WOODS PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1058
Mailing Address - Country:US
Mailing Address - Phone:414-332-6262
Mailing Address - Fax:414-332-0422
Practice Address - Street 1:525 W RIVER WOODS PARKWAY
Practice Address - Street 2:STE 130
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53212
Practice Address - Country:US
Practice Address - Phone:414-961-0304
Practice Address - Fax:414-961-2061
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2019-10-24
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Provider Licenses
StateLicense IDTaxonomies
WI38539207XS0114X
WI38539-020207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
200045640OtherRAILROAD MEDICARE
WI34079800Medicaid
000646155Medicare PIN
WIH35345Medicare UPIN
200045640OtherRAILROAD MEDICARE