Provider Demographics
NPI:1114095817
Name:STEVEN A PORTNEY, MD, PC
Entity Type:Organization
Organization Name:STEVEN A PORTNEY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PORTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:248-552-0242
Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-6210
Mailing Address - Country:US
Mailing Address - Phone:248-552-0242
Mailing Address - Fax:248-552-8418
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE #200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6210
Practice Address - Country:US
Practice Address - Phone:248-552-0242
Practice Address - Fax:248-552-8418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNSP057396207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE80769Medicare UPIN