Healthcare Provider Details

I. General information

NPI: 1043424765
Provider Name (Legal Business Name): JOHN C STEPHENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27901 WOODWARD AVE STE 300 BEAUMONT NORTHPOINTE HEART CENTER
BERKLEY MI
48072-0921
US

IV. Provider business mailing address

130 TOWN CENTER DR STE 203 BEAUMONT MEDICAL STAFF AFFAIRS
TROY MI
48084-1744
US

V. Phone/Fax

Practice location:
  • Phone: 248-545-0070
  • Fax: 248-545-4850
Mailing address:
  • Phone: 248-585-8218
  • Fax: 248-585-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301076543
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.091874
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number141984
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: