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General NPI Number Information
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NPI Number | 1972819134
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Entity Type | Organization
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Legal Business Name | D L STAGEMAN MD PLC
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | 926 WASHINGTON AVE BLD D STE 230
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City | HOLLAND
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State | MI
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Zip | 49423-7725
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Country | US
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Telephone | 616-396-3544
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Fax | 616-396-3548
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Provider Business Mailing Address
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Address Line | 926 WASHINGTON AVE BLD D STE 230
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City | HOLLAND
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State | MI
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Zip | 49423-7725
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Country | US
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Telephone | 616-396-3544
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Fax | 616-396-3548
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Authorized Official
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Title or Position | OWNER
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Name | DONALD L STAGEMAN
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Credential | MD
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Telephone | 616-396-3544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 4301039644
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License Number State | MI
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