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NPI Code Detail

MEDICARE: PETER STEPHAN DO

MEDICARE: PETER STEPHAN DO
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
1208000000XPediatrics Physician5151016128MI

General Provider Information

NPI Number : 1821780750
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER STEPHAN DO
Provider Business Mailing Address
First Line : 1215 E MICHIGAN AVE
Second Line :
City : LANSING
State : MI
Zip : 48912-1811
Country : US
Telephone Number : 517-364-1000
Fax Number :
Provider Business Practice Location Address
First Line : 1215 E MICHIGAN AVE
Second Line :
City : LANSING
State : MI
Zip : 48912-1811
Country : US
Telephone Number : 517-364-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2023
Last Update Date : 02/17/2026

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Directions to “ PETER STEPHAN DO” Practice Location

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