Healthcare Provider Details

I. General information

NPI: 1609870526
Provider Name (Legal Business Name): EDWARD THOMAS STERN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 43RD ST SE STE 700
GRAND RAPIDS MI
49508-3717
US

IV. Provider business mailing address

2120 43RD ST SE STE 700
GRAND RAPIDS MI
49508-3717
US

V. Phone/Fax

Practice location:
  • Phone: 616-455-6700
  • Fax: 616-455-7487
Mailing address:
  • Phone: 616-455-6700
  • Fax: 616-455-7487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number4301039905
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: