Healthcare Provider Details

I. General information

NPI: 1457336711
Provider Name (Legal Business Name): SHELLY RAE STEMPFLE PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLY CELSKE PA C

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 06/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25311 LITTLE MACK AVE SUITE B
ST CLAIR SHORES MI
48081-3370
US

IV. Provider business mailing address

8301 RELIABLE PKWY
CHICAGO IL
60686-0001
US

V. Phone/Fax

Practice location:
  • Phone: 586-498-2400
  • Fax: 586-498-2800
Mailing address:
  • Phone: 586-498-2400
  • Fax: 586-498-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003594
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: