Healthcare Provider Details

I. General information

NPI: 1346246337
Provider Name (Legal Business Name): JULIE M STEVENS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N MISSION
MOUNT PLEASANT MI
48858
US

IV. Provider business mailing address

9511 S CRAWFORD RD
SHEPHERD MI
48883-8504
US

V. Phone/Fax

Practice location:
  • Phone: 989-773-3789
  • Fax: 989-773-6677
Mailing address:
  • Phone: 989-828-5763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJS013404
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: