Provider Demographics
NPI:1033467493
Name:EDWARD J. STEHOUWER, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:EDWARD J. STEHOUWER, M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEHOUWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-728-5567
Mailing Address - Street 1:1675 LEAHY ST
Mailing Address - Street 2:SUITE 300 - B
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5500
Mailing Address - Country:US
Mailing Address - Phone:231-728-5567
Mailing Address - Fax:231-725-7134
Practice Address - Street 1:1675 LEAHY ST
Practice Address - Street 2:SUITE 300 - B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5500
Practice Address - Country:US
Practice Address - Phone:231-728-5567
Practice Address - Fax:231-725-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI38469208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty