Provider Demographics
NPI:1093716003
Name:STEVENS, MARIA THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:THERESA
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11232 N 44TH CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3007
Mailing Address - Country:US
Mailing Address - Phone:602-821-6569
Mailing Address - Fax:602-530-6901
Practice Address - Street 1:1510 E FLOWER ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5656
Practice Address - Country:US
Practice Address - Phone:602-821-6569
Practice Address - Fax:602-530-6901
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27065207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ506446Medicaid
AZAZ0753760OtherBC/BS
AZ7378666OtherAETNA
H20183Medicare UPIN
AZ80812Medicare ID - Type Unspecified