Provider Demographics
NPI:1982137014
Name:DIGIANDOMENICO, STEFANIE (MD)
Entity type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:
Last Name:DIGIANDOMENICO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 N 92ND ST
Mailing Address - Street 2:SUITE 730
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4875
Mailing Address - Country:US
Mailing Address - Phone:414-337-7030
Mailing Address - Fax:414-337-7068
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-4875
Practice Address - Country:US
Practice Address - Phone:404-712-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA887162080P0207X, 207RH0000X
WI70536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology