Provider Demographics
NPI:1174581904
Name:STEIN, JOHN ANDREW (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:STEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4231
Practice Address - Street 1:629 N SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-1821
Practice Address - Country:US
Practice Address - Phone:419-562-4677
Practice Address - Fax:419-562-0987
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073529207P00000X
OH35.073529207P00000X, 207Q00000X
OH35073529S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000246014OtherBCBS MARION
OH2127693Medicaid
OH930117503OtherRR MEDICARE MARION
P00088844OtherRR MEDICARE FOR BUCYRUS
OH000000316697OtherBCBS FOR BUCYRUS
000000384399OtherBCBS
OH000000246014OtherBCBS MARION
000000384399OtherBCBS
G95767Medicare UPIN
ST0879436Medicare PIN
OHST0879433Medicare PIN
ST0879435Medicare PIN