Healthcare Provider Details

I. General information

NPI: 1851363105
Provider Name (Legal Business Name): STEPHANIE L CRAIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 FORT ST
TRENTON MI
48183-4601
US

IV. Provider business mailing address

1651 KINGSWAY CT SUITE A
TRENTON MI
48183-1959
US

V. Phone/Fax

Practice location:
  • Phone: 734-671-3950
  • Fax:
Mailing address:
  • Phone: 734-671-2110
  • Fax: 734-671-5344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101015086
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: