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General NPI Number Information
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NPI Number | 1205366572
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Entity Type | Individual
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Provider Name | STEPHANIE ANN ABUL MD
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Gender | Female
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Dates
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Enumeration Date | 06/19/2017
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 33875 KIELY DR
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City | CHESTERFIELD
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State | MI
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Zip | 48047-3604
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Country | US
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Telephone | 586-725-6030
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Fax |
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Provider Business Mailing Address
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Address Line | 4345 WINTERWOOD LN
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City | SAGINAW
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State | MI
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Zip | 48603-8672
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Country | US
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Telephone | 989-996-3269
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 4301500798
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License Number State | MI
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