Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 01049062A | IN |
NPI | 1023011004 |
---|---|
Provider Name | David S Stensland |
First Address | Fort Wayne, IN 46804-2228 |
Second Address | Fort Wayne, IN 46804-2228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 27/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200248290A | (05) | IN |
H03918 | (02) | IN |
P00397695 | RR MEDICARE (01) | IN |