Healthcare Provider Details

I. General information

NPI: 1700072014
Provider Name (Legal Business Name): MICHAEL J. STEVENS CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 TOMAHAWK DR
MAUMEE OH
43537-1633
US

IV. Provider business mailing address

419 TOMAHAWK DR
MAUMEE OH
43537-1633
US

V. Phone/Fax

Practice location:
  • Phone: 419-893-0748
  • Fax: 419-891-9172
Mailing address:
  • Phone: 419-893-0748
  • Fax: 419-891-9172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberLPO.120
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: