Healthcare Provider Details

I. General information

NPI: 1356371728
Provider Name (Legal Business Name): STEVEN J FERRUCCI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16151 19 MILE ROAD, SUITE 300
CLINTON TOWNSHIP MI
48038
US

IV. Provider business mailing address

16151 19 MILE ROAD, SUITE 300
CLINTON TOWNSHIP MI
48038
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-1760
  • Fax: 586-228-2672
Mailing address:
  • Phone: 586-228-1760
  • Fax: 586-228-2672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number055712
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: