Healthcare Provider Details

I. General information

NPI: 1821025602
Provider Name (Legal Business Name): STEPHEN JAMES PALAJAC DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20927 KELLY RD
EASTPOINTE MI
48021-3128
US

IV. Provider business mailing address

14825 W MCNICHOLS RD
DETROIT MI
48235-3939
US

V. Phone/Fax

Practice location:
  • Phone: 586-777-8801
  • Fax:
Mailing address:
  • Phone: 734-772-4722
  • Fax: 248-509-4070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberJP002254
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: