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General NPI Number Information
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NPI Number | 1154700854
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Entity Type | Individual
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Provider Name | STEPHEN BRANDON LUCZAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 2305 GENOA BUSINESS PARK DR STE 120
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City | BRIGHTON
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State | MI
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Zip | 48114-7004
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Country | US
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Telephone | 810-844-7785
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Fax | 810-844-7567
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DR STE J2000
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City | ANN ARBOR
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State | MI
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Zip | 48105-9484
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Country | US
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Telephone | 734-747-6766
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Fax | 734-222-3100
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 4301107440
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License Number State | MI
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