=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851114268
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRED W. STELSON, M.D. PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2024
-----------------------------------------------------
Last Update Date | 03/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 559 WAYMARKET DR
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103-6621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-277-2809
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 559 WAYMARKET DR
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103-6621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-277-2809
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. FRED WOOLLEY STELSON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 734-496-0157
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------