Healthcare Provider Details

I. General information

NPI: 1376534164
Provider Name (Legal Business Name): STEPHEN M TAIT MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 04/24/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7329 GRAND RIVER RD
BRIGHTON MI
48114-9340
US

IV. Provider business mailing address

7329 GRAND RIVER RD
BRIGHTON MI
48114-9390
US

V. Phone/Fax

Practice location:
  • Phone: 810-474-3937
  • Fax: 810-474-3940
Mailing address:
  • Phone: 810-474-3937
  • Fax: 810-474-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301074678
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: