MEDICARE: YEVGENIY G STEFADU M.D., PH.D

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	4301074792	MI
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	4301074792	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316913270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEVGENIY G STEFADU M.D., PH.D

Provider Business Mailing Address
First Line	:	5215 CROWFOOT DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-4095
Country	:	US
Telephone Number	:	248-709-6158
Fax Number	:	586-268-5818

Provider Business Practice Location Address
First Line	:	3058 METROPOLITAN PKWY
Second Line	:	#108
City	:	STERLING HTS
State	:	MI
Zip	:	48310-3671
Country	:	US
Telephone Number	:	586-268-0100
Fax Number	:	586-268-5818

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	11/18/2012

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