Healthcare Provider Details

I. General information

NPI: 1932142650
Provider Name (Legal Business Name): MICHAEL M STEFAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W LINCOLN HWY
EXTON PA
19341-2547
US

IV. Provider business mailing address

730 W LINCOLN HWY
EXTON PA
19341-2547
US

V. Phone/Fax

Practice location:
  • Phone: 610-827-1707
  • Fax: 610-827-1708
Mailing address:
  • Phone: 610-827-1707
  • Fax: 610-827-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD036398E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1932142650
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNPI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: