Provider Demographics
NPI:1043292774
Name:PERRY, STEPHEN P (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11051 HALL RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5735
Mailing Address - Country:US
Mailing Address - Phone:586-726-6556
Mailing Address - Fax:586-726-4917
Practice Address - Street 1:11051 HALL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5735
Practice Address - Country:US
Practice Address - Phone:586-726-6556
Practice Address - Fax:586-726-4917
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301061435207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G18778Medicare UPIN
OM56200Medicare ID - Type Unspecified