Healthcare Provider Details

I. General information

NPI: 1164817219
Provider Name (Legal Business Name): ELIZABETH THERESA STEPHENS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH THERESA SUTTER

II. Dates (important events)

Enumeration Date: 04/04/2015
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST STE M-005
KALAMAZOO MI
49007-5381
US

IV. Provider business mailing address

43 WHITING HILL RD STE 300
BREWER ME
04412-1006
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-6350
  • Fax:
Mailing address:
  • Phone: 207-973-5000
  • Fax: 207-973-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberDO3266
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number5101027710
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: