Individual
MR. STEPHEN JOHN VANWYLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
709 4TH AVE NE, WATFORD CITY, ND 58854-7628
(701) 842-3771
(701) 842-4025
Mailing address
709 4TH AVE NE, WATFORD CITY, ND 58854-7628
(701) 842-3771
(701) 842-4025
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
43010402855
MI
208600000X
Surgery Physician
Primary
8806
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020G010060
BLUE CROSS BLUE SHIELD MI
MI
05
—
1916935
—
MI
01
—
382809956
COMMERCIAL
—
05
—
71992
—
ND
Enumeration date
04/26/2006
Last updated
10/18/2024
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