Individual
DR. STEPHEN NYSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
855 N WESTHAVEN DR, OSHKOSH, WI 54904
(920) 303-8700
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
5101017624
MI
207X00000X
Orthopaedic Surgery Physician
Primary
68888-21
WI
207X00000X
Orthopaedic Surgery Physician
OS12697
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013076600
—
FL
05
—
100075914
—
WI
01
—
14V7E
BCBS FL
FL
01
—
P01408649
RAILROAD MEDICARE
FL
Enumeration date
06/11/2008
Last updated
03/27/2024
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