Healthcare Provider Details

I. General information

NPI: 1275718553
Provider Name (Legal Business Name): FRED WOOLLEY STELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 11/25/2024
Certification Date: 11/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 WAYMARKET DR
ANN ARBOR MI
48103-6621
US

IV. Provider business mailing address

559 WAYMARKET DR
ANN ARBOR MI
48103-6621
US

V. Phone/Fax

Practice location:
  • Phone: 734-277-2809
  • Fax:
Mailing address:
  • Phone: 734-496-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number4301056585
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301056585
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301056585
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: