Provider Demographics
NPI:1548264336
Name:STOVER, PAUL MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:STOVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-683-5278
Mailing Address - Fax:920-686-9674
Practice Address - Street 1:2806 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-6717
Practice Address - Country:US
Practice Address - Phone:920-498-7546
Practice Address - Fax:920-569-4129
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI38944-020207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000817140OtherMEDICARE
WI1548264336Medicaid
WIP00338098OtherRAILROAD MEDICARE
WI38944-020OtherSTATE LICENSE
WI38944-020OtherSTATE LICENSE
WI1548264336Medicaid