Healthcare Provider Details

I. General information

NPI: 1083541379
Provider Name (Legal Business Name): JONAH L STEPHENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 SCHAEFER RD
DEARBORN MI
48126-2212
US

IV. Provider business mailing address

6451 SCHAEFER RD
DEARBORN MI
48126-2212
US

V. Phone/Fax

Practice location:
  • Phone: 313-945-8380
  • Fax: 313-624-9417
Mailing address:
  • Phone: 313-945-8380
  • Fax: 313-624-9417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: