Basic Information
| Provider Information | |||||||||
| NPI: | 1023011004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STENSLAND | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7201 ENGLE RD | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468042228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604321800 | ||||||||
| FaxNumber: | 2604321804 | ||||||||
| Practice Location | |||||||||
| Address1: | 7201 ENGLE RD | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468042228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604321800 | ||||||||
| FaxNumber: | 2604321804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 06/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 01049062A | IN | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 200248290A | 05 | IN | MEDICAID | P00397695 | 01 | IN | RR MEDICARE | OTHER |