Healthcare Provider Details

I. General information

NPI: 1639137961
Provider Name (Legal Business Name): STEPHEN MICHAEL MANIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 LAKESHORE DRIVE
ESCANABA MI
49829
US

IV. Provider business mailing address

PO BOX 1108
ANN ARBOR MI
48106-1108
US

V. Phone/Fax

Practice location:
  • Phone: 734-677-7400
  • Fax: 734-677-7407
Mailing address:
  • Phone: 734-677-7400
  • Fax: 734-677-7407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301060550
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: