Stephanie Icabone, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301517563 Issued in MI

Practice address

30695 Little Mack Ave Ste 200
Roseville, MI 48066-1781

Phone

(586) 294-9600

NPI assigned

Jun 20, 2023

Last updated

Oct 1, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: stephanie.icabone.1@14250.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790812800000",
    "number": "1740965300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30695 LITTLE MACK AVE STE 200",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480661781",
            "telephone_number": "586-294-9600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "468 Cadieux Rd",
            "address_purpose": "LOCATION",
            "city": "Grosse Pointe",
            "state": "MI",
            "postal_code": "482301507",
            "country_code": "US",
            "telephone_number": "586-498-4422",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ICABONE",
        "first_name": "STEPHANIE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-20",
        "last_updated": "2026-10-01",
        "certification_date": "2026-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301517563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sroskelly1253531@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "30695 Little Mack Ave Ste 200",
            "city": "Roseville",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480661781",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Ignite 3 LLC
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• In Home Rehab,LLC
• Independent Nursing Services
• Index Meds Pharmacy No-3 LLC

• Family Medicine Physician in Roseville, MI
• Providers in Roseville, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.