MEDICARE: GREGORY E STEPHENS DO PC

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	174400000X	Specialist	5101010374	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0158223820	OTHER	MI	BLUE CROSS OF MICHIGAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588835433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY E STEPHENS DO PC

Provider Business Mailing Address
First Line	:	14600 KING RD
Second Line	:	SUITE D
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-7952
Country	:	US
Telephone Number	:	734-479-7310
Fax Number	:

Provider Business Practice Location Address
First Line	:	18174 MERIDIAN RD
Second Line	:
City	:	GROSSE ILE
State	:	MI
Zip	:	48138-1088
Country	:	US
Telephone Number	:	313-282-5824
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. GREGORY E STEPHENS
Credential	:	D.O.
Telephone Number	:	734-479-7310

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	01/03/2025

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