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NPI Code Detail

MEDICARE: DR. EDWARD THOMAS STERN M.D.

MEDICARE: DR. EDWARD THOMAS STERN M.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
1207K00000XAllergy & Immunology Physician4301039905MI

Other Identifiers

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

General Provider Information

NPI Number : 1609870526
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD THOMAS STERN M.D.
Provider Business Mailing Address
First Line : 2120 43RD ST SE
Second Line : STE 700
City : GRAND RAPIDS
State : MI
Zip : 49508-3717
Country : US
Telephone Number : 616-455-6700
Fax Number : 616-455-7487
Provider Business Practice Location Address
First Line : 2120 43RD ST SE
Second Line : STE 700
City : GRAND RAPIDS
State : MI
Zip : 49508-3717
Country : US
Telephone Number : 616-455-6700
Fax Number : 616-455-7487
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 07/08/2007

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