Gregory E Stephens, D.O.
Individual provider Active NPI Otolaryngology/Facial Plastic Surgery Physician · Grosse Ile, MI
NPI 1962494526 · NPPES record last updated Dec 20, 2024
Key facts
- NPI
- 1962494526
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Otolaryngology/Facial Plastic Surgery Physician 207YX0905X
- License
- 5101010374 (MI)
- Practice address
- 18174 Meridian Rd
Grosse Ile, MI 48138-1088 - Phone
- (313) 282-5824
- Fax
- (000) 000-0000
- NPI assigned
- Aug 19, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology/Facial Plastic Surgery Physician | 207YX0905X | 5101010374 | MI | Yes |
Addresses
Primary practice location
18174 Meridian Rd
Grosse Ile, MI 48138-1088
Mailing address
18174 Meridian Rd
Grosse Ile, MI 48138-1088
Phone (313) 282-5824
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C5211 | Other | MI | MCARE |
| 0158223820 | Other | MI | BLUE CROSS MICHIGAN |
| P85024 | Other | MI | BLUE CARE NETWORK |
| 3086232 | Medicaid | MI | |
| 383461449 | Other | MI | FEDERAL TAX ID |
Other providers in Grosse Ile, MI
- Alexis Schankowski
- Lena Silmi
- Karen Lynn Snyder
- Troy Soncrant
- Star Infusion and Compression Therapies LLC
- Billie Jo Stopa
- Roberta R Synowiec
- Sarah R Toboy
- Township of Grosse Ile
- Tricounty Nurses Plus,LLC
All providers in Grosse Ile, MI · Otolaryngology/Facial Plastic Surgery Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.