Provider Demographics
NPI:1053461590
Name:STEPHAN, NAMIR YOUSIF (MD)
Entity Type:Individual
Prefix:
First Name:NAMIR
Middle Name:YOUSIF
Last Name:STEPHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 BENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3302
Mailing Address - Country:US
Mailing Address - Phone:248-601-9200
Mailing Address - Fax:248-601-9937
Practice Address - Street 1:75 BARCLAY CIR
Practice Address - Street 2:SUITE 230
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5820
Practice Address - Country:US
Practice Address - Phone:248-856-6600
Practice Address - Fax:248-856-6601
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062490207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION15750001Medicare ID - Type Unspecified
MIG58859Medicare UPIN