Healthcare Provider Details

I. General information

NPI: 1669615506
Provider Name (Legal Business Name): GRETCHEN ELIZABETH STEPANOVICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E HOSPITAL DR
ANN ARBOR MI
48109-4000
US

IV. Provider business mailing address

1540 E HOSPITAL DR
ANN ARBOR MI
48109-4000
US

V. Phone/Fax

Practice location:
  • Phone: 734-232-0334
  • Fax:
Mailing address:
  • Phone: 342-320-3347
  • Fax: 858-966-7483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101251518
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4301116961
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: