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Individual

STEPHEN R DERNLAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3916 N INTERTECH CT, APPLETON, WI 54913
(920) 996-1000
(920) 997-8302
Mailing address
3916 N INTERTECH CT, APPLETON, WI 54913
(920) 996-1000
(920) 997-8302

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
30115-020
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
31480500
WI
01
P00062904
RR MEDICARE
Enumeration date
07/06/2006
Last updated
06/01/2023
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