Provider Demographics
NPI:1518427103
Name:HURWITZ, STEPHANIE NICOLE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:HURWITZ
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 W WALNUT ST # R3C321C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5188
Mailing Address - Country:US
Mailing Address - Phone:941-780-2037
Mailing Address - Fax:
Practice Address - Street 1:350 W 11TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4108
Practice Address - Country:US
Practice Address - Phone:317-491-6000
Practice Address - Fax:317-491-6534
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD479784207ZC0006X
IN01093855A207ZH0000X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300094259Medicaid