Healthcare Provider Details

I. General information

NPI: 1396892105
Provider Name (Legal Business Name): NATALIE NAZARK STEFAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 AUTO CLUB DR HENRY FORD HEALTH SYSTEM
DEARBORN MI
48126-2683
US

IV. Provider business mailing address

5500 AUTO CLUB DR HENRY FORD HEALTH SYSTEM
DEARBORN MI
48126-2683
US

V. Phone/Fax

Practice location:
  • Phone: 313-425-4700
  • Fax: 313-425-4700
Mailing address:
  • Phone: 313-425-4700
  • Fax: 313-425-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301052279
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: