MEDICARE: DR. GREGORY E STEPHENS D.O.

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	5101010374	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C5211	OTHER	MI	MCARE
2	0158223820	OTHER	MI	BLUE CROSS MICHIGAN
3	P85024	OTHER	MI	BLUE CARE NETWORK
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	383461449	OTHER	MI	FEDERAL TAX ID

General Provider Information

NPI Number	:	1962494526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY E STEPHENS D.O.

Provider Business Mailing 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	:

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	12/20/2024

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