Healthcare Provider Details

I. General information

NPI: 1437158862
Provider Name (Legal Business Name): STEPHEN A LIROFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 W MAPLE RD
WEST BLOOMFIELD MI
48322-3013
US

IV. Provider business mailing address

6777 W MAPLE RD
WEST BLOOMFIELD MI
48322-3013
US

V. Phone/Fax

Practice location:
  • Phone: 248-661-7080
  • Fax: 248-661-7543
Mailing address:
  • Phone: 248-661-7080
  • Fax: 248-661-7543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301034273
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: