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General NPI Number Information
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NPI Number | 1164750949
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Entity Type | Organization
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Legal Business Name | TOMMY S. STEVENS M.D., P.C.
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 12/29/2009
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Provider Practice Location Address
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Address Line | 2298 S CENTER RD
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City | BURTON
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State | MI
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Zip | 48519-1166
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Country | US
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Telephone | 810-742-2544
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Fax | 810-742-2566
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Provider Business Mailing Address
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Address Line | 2298 S CENTER RD
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City | BURTON
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State | MI
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Zip | 48519-1166
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Country | US
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Telephone | 810-742-2544
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Fax | 810-742-2566
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LORRAINE EDELEN-STEVENS
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Credential |
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Telephone | 810-742-2544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | TS039213
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License Number State | MI
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