Individual
LYLE J STEFANICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1825 LOGAN AVE, WATERLOO, IA 50703-1916
(319) 235-3886
Mailing address
2414 MINNETONKA DR, CEDAR FALLS, IA 50613-1526
(240) 543-3755
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
28763
OK
207L00000X
Anesthesiology Physician
Primary
39601
IA
207L00000X
Anesthesiology Physician
49054
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
312182000
—
MN
Enumeration date
08/08/2006
Last updated
04/02/2021
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