Healthcare Provider Details

I. General information

NPI: 1720427487
Provider Name (Legal Business Name): STEPHANIE BETH MARCUS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27332 WOODWARD AVE SUTE 100
ROYAL OAK MI
48067-0900
US

IV. Provider business mailing address

27332 WOODWARD AVE SUTE 100
ROYAL OAK MI
48067-0900
US

V. Phone/Fax

Practice location:
  • Phone: 248-543-1545
  • Fax:
Mailing address:
  • Phone: 248-543-1545
  • Fax: 248-551-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301103305
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: