Healthcare Provider Details

I. General information

NPI: 1790135986
Provider Name (Legal Business Name): STEVEN ISTEPHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 S TELEGRAPH RD
MONROE MI
48161-1611
US

IV. Provider business mailing address

419 S TELEGRAPH RD
MONROE MI
48161-1611
US

V. Phone/Fax

Practice location:
  • Phone: 734-241-1100
  • Fax: 734-241-5114
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number4301118927
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: