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Individual

STEPHEN CONLON EDER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5215 HOLY CROSS PKWY, EMERGENCY DEPARTMENT, MISHAWAKA, IN 46545-1469
(574) 335-5000
Mailing address
5215 HOLY CROSS PKWY, EMERGENCY DEPARTMENT, MISHAWAKA, IN 46545-1469
(574) 335-5000

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01065201
IN
390200000X
Student in an Organized Health Care Education/Training Program
125049846
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000570234
ANTHEM
IN
05
200901660
IN
01
P00638189
RAILROAD MEDICARE
IN
Enumeration date
04/03/2008
Last updated
12/16/2011
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