Basic Information
Provider Information | |||||||||
NPI: | 1821056912 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HILLEMANN | ||||||||
FirstName: | STEFFEN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 50 TIMBER LN | ||||||||
Address2: |   | ||||||||
City: | SOUTH BURLINGTON | ||||||||
State: | VT | ||||||||
PostalCode: | 054037204 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8028626312 | ||||||||
FaxNumber: | 8026583984 | ||||||||
Practice Location | |||||||||
Address1: | 364 DORSET ST | ||||||||
Address2: | SUITE 1 | ||||||||
City: | SOUTH BURLINGTON | ||||||||
State: | VT | ||||||||
PostalCode: | 054036270 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8028626312 | ||||||||
FaxNumber: | 8026583984 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/01/2006 | ||||||||
LastUpdateDate: | 09/24/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 042-0009918 | VT | N |   | Other Service Providers | Specialist |   | 207RC0000X | 042-0009918 | VT | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
ID | Type | State | Issuer | Description | 1009847 | 05 | VT |   | MEDICAID | P00057516 | 01 | VT | RR MEDICARE | OTHER | 02421598 | 05 | NY |   | MEDICAID |