Provider Demographics
NPI:1700879780
Name:PRZYNOSCH, STEPHEN L (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:PRZYNOSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5700 MONROE ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2735
Mailing Address - Country:US
Mailing Address - Phone:419-291-2670
Mailing Address - Fax:419-479-6999
Practice Address - Street 1:5700 MONROE ST UNIT 201
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2735
Practice Address - Country:US
Practice Address - Phone:419-291-2670
Practice Address - Fax:419-479-6999
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35079038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH080185193OtherRRMC
OH04187OtherPHC
OH000000235269OtherANTHEM
OH01-10519OtherUHC
OH2317835Medicaid
OH7124387OtherAETNA
$$$$$$$$$00OtherOH BWC
OH000000235269OtherANTHEM
OH7124387OtherAETNA
$$$$$$$$$-001OtherMMO
OH01-10519OtherUHC