Healthcare Provider Details

I. General information

NPI: 1982802245
Provider Name (Legal Business Name): AARON STUART CETNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 ORCHARD LAKE RD SUITE 120
WEST BLOOMFIELD MI
48322-2398
US

IV. Provider business mailing address

2051 PLAINFIELD RD
CREST HILL IL
60403-1865
US

V. Phone/Fax

Practice location:
  • Phone: 248-694-6390
  • Fax: 248-694-6391
Mailing address:
  • Phone: 815-741-4343
  • Fax: 815-741-8660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberAC093636
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number036.118454
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: