Healthcare Provider Details

I. General information

NPI: 1245236439
Provider Name (Legal Business Name): STEPHEN T. WEBSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 LAFAYETTE AVE SE STE 400
GRAND RAPIDS MI
49503-4693
US

IV. Provider business mailing address

310 LAFAYETTE AVE SE STE 400
GRAND RAPIDS MI
49503-4693
US

V. Phone/Fax

Practice location:
  • Phone: 616-752-6525
  • Fax: 616-752-6556
Mailing address:
  • Phone: 616-752-6525
  • Fax: 616-752-6556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301062408
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: