Individual
STEPHANIE DETTERLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35089436
OH
207R00000X
Internal Medicine Physician
36113740
IL
207R00000X
Internal Medicine Physician
Primary
D67439
MD
208M00000X
Hospitalist Physician
036113740
IL
208M00000X
Hospitalist Physician
35089436
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200867020
—
IN
05
—
2745748
—
OH
05
—
36113740
—
IL
05
—
7100007510
—
KY
Enumeration date
02/15/2006
Last updated
11/21/2011
Update your record
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