MEDICARE: STEPHEN D MIGDAL 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
1	207R00000X	Internal Medicine Physician	4301029339	MI
2	207RN0300X	Nephrology Physician	4301029339	MI

General Provider Information

NPI Number	:	1295775757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN D MIGDAL MD

Provider Business Mailing Address
First Line	:	1560 E MAPLE RD
Second Line	:	SUITE 400-CREDENTIALING
City	:	TROY
State	:	MI
Zip	:	48083-1138
Country	:	US
Telephone Number	:	313-745-4525
Fax Number	:	313-745-0011

Provider Business Practice Location Address
First Line	:	4160 JOHN R ST
Second Line	:	SUITE 917
City	:	DETROIT
State	:	MI
Zip	:	48201-2017
Country	:	US
Telephone Number	:	313-745-4525
Fax Number	:	313-745-0011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	10/27/2016

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Directions to “ STEPHEN D MIGDAL MD” Practice Location

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