Eselgroth, Stephan F
Eselgroth, Stephan F is an individual health care provider with primary practice located at 1013 Executive Dr Ste 102 , Hixson TN 37343-7913. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Neuromusculoskeletal Medicine, Sports Medicine. Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation is his primary health care specialty. Eselgroth, Stephan F can be contacted via phone (423) 316-3614.Contact Information
Primary practice address
1013 Executive Dr Ste 102
Hixson TN 37343-7913
Phone: (423) 316-3614
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation | 208100000X | 36659 | Kentucky |
| Allopathic & Osteopathic Physicians / Neuromusculoskeletal Medicine, Sports Medicine | 204C00000X | MD0000036511 | Tennessee |
| Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation | 208100000X | MD0000036511 | Tennessee |
Profile Details
| NPI number | 1912902099 |
|---|---|
| LBN Legal business name | Eselgroth, Stephan F |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 16th, 2005 |
| Last updated | May 26th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912902099 | NPPES |
| Tennessee | Other | MD0000036511 | TN MEDICAL LICENSE NUMBER |
| Tennessee | Other | 4051823 | TN MEDICAL LICENSE NUMBER |
| Tennessee | Other | 36659 | TN MEDICAL LICENSE NUMBER |
| Tennessee | Other | 250014020 | TN MEDICAL LICENSE NUMBER |
| Tennessee | MEDICAID | 3879076 | TN MEDICAL LICENSE NUMBER |
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