Individual
DR. WILLIS W STEVENSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2310 CALIFORNIA ROAD, ELKHART, IN 46514-1228
(574) 264-4163
(574) 262-9650
Mailing address
2310 CALIFORNIA ROAD, ELKHART, IN 46514-1228
(574) 264-4163
(574) 262-9650
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
01062348A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01062348A
MEDICAL LICENSE
IN
05
—
200847880
—
IN
Enumeration date
01/18/2007
Last updated
03/07/2023
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