Provider Demographics
NPI:1114028255
Name:DALM, STEPHEN CHRISTIAN (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHRISTIAN
Last Name:DALM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5060 CASCADE RD SE
Mailing Address - Street 2:STE C
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3808
Mailing Address - Country:US
Mailing Address - Phone:616-247-1700
Mailing Address - Fax:616-247-3679
Practice Address - Street 1:5060 CASCADE RD SE
Practice Address - Street 2:STE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3808
Practice Address - Country:US
Practice Address - Phone:616-247-1700
Practice Address - Fax:616-247-3679
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI008560207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160D110280OtherBCBS
MI2739380Medicaid
MI160D110280OtherBCBS
MIA76061Medicare UPIN