Basic Information
| Provider Information | |||||||||
| NPI: | 1578587770 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEKANICH | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 RIO GRANDE ST STE 340 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787011162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127955500 | ||||||||
| FaxNumber: | 5127953502 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 E 15TH ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787011930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123247000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 12/14/2012 | ||||||||
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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 | 207R00000X | 4917279-1205 | UT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0002X | ME107455 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 176551302 | 05 | TX | MEDICAID | 8DD740 | 01 | TX | BCBS | OTHER |