Basic Information
| Provider Information | |||||||||
| NPI: | 1164627501 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STIDHAM | ||||||||
| FirstName: | KALLE | ||||||||
| MiddleName: | MARC | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 ARGUELLO ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940631566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6508514900 | ||||||||
| FaxNumber: | 6509951202 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 S WINCHESTER BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951282544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6508514900 | ||||||||
| FaxNumber: | 4085568415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2007 | ||||||||
| LastUpdateDate: | 04/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 20A10063 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.