MEDICARE: SEAN RAYL STEPHENSON 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
1	208D00000X	General Practice Physician	5101016669	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942219621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN RAYL STEPHENSON DO

Provider Business Mailing Address
First Line	:	305 N LEROY ST
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-2729
Country	:	US
Telephone Number	:	810-629-0336
Fax Number	:	810-629-7251

Provider Business Practice Location Address
First Line	:	305 N LEROY ST
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-2729
Country	:	US
Telephone Number	:	810-629-0336
Fax Number	:	810-629-7251

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	04/30/2008

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Directions to “ SEAN RAYL STEPHENSON DO” Practice Location

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