Individual
DR. STEPHAN F ESELGROTH
Active
Individual
DR. STEPHAN F ESELGROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
MD0000036511
TN
208100000X
Physical Medicine & Rehabilitation Physician
36659
KY
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD0000036511
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
250014020
RR MEDICARE
TN
01
—
36659
KY MEDICAL LICENSE NUMBER
KY
05
—
3879076
—
TN
01
—
4051823
BCBS ID NUMBER
TN
01
—
MD0000036511
TN MEDICAL LICENSE NUMBER
TN
Enumeration date
06/16/2005
Last updated
12/03/2025
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