MEDICARE: DR. EDWARD JOHN STEHOUWER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	38469	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2806100372	OTHER	MI	BLUE CROSS BLUE SHIELD OF
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2806100372	OTHER		BLUE CARE NETWORK
4	2806100372	OTHER		BLUE CHOICE

General Provider Information

NPI Number	:	1679649768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD JOHN STEHOUWER MD

Provider Business Mailing Address
First Line	:	1675 LEAHY STREET
Second Line	:	SUITE 300
City	:	MUSKEGON
State	:	MI
Zip	:	49442-5543
Country	:	US
Telephone Number	:	231-728-5567
Fax Number	:	231-725-7134

Provider Business Practice Location Address
First Line	:	1675 LEAHY STREET
Second Line	:	SUITE 300
City	:	MUSKEGON
State	:	MI
Zip	:	49442-5543
Country	:	US
Telephone Number	:	231-728-5567
Fax Number	:	231-725-7134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	03/17/2008

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Directions to “ DR. EDWARD JOHN STEHOUWER MD” Practice Location

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