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NPI Code Detail

MEDICARE: ALFRED NATHAN STANFORD MD

MEDICARE: ALFRED NATHAN STANFORD MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianMD0029176WA
22085R0202XDiagnostic Radiology PhysicianMDE00029176WA
32085R0202XDiagnostic Radiology Physician4301108685MI

General Provider Information

NPI Number : 1053381079
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALFRED NATHAN STANFORD MD
Provider Business Mailing Address
First Line : 3621 SOUTH STATE STREET
Second Line : 700 KMS PLACE
City : ANN ARBOR
State : MI
Zip : 48108
Country : US
Telephone Number : 734-936-2047
Fax Number :
Provider Business Practice Location Address
First Line : 1500 EAST MEDICAL CENTER DRIVE
Second Line : B1 FLOOR UNIVERSITY HOSPITAL RECP C
City : ANN ARBOR
State : MI
Zip : 48109-5030
Country : US
Telephone Number : 734-936-4566
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2006
Last Update Date : 10/16/2015

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