Healthcare Provider Details

I. General information

NPI: 1073573861
Provider Name (Legal Business Name): STEFANI J HINES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30503 GREENFIELD RD
SOUTHFIELD MI
48076-1594
US

IV. Provider business mailing address

26901 BEAUMONT BLVD
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 248-691-4744
  • Fax: 248-691-4745
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number4301068584
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: