Provider Demographics
NPI:1114908977
Name:STENZ, ROBERT MOORE (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MOORE
Last Name:STENZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3273 DAVISON RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2902
Mailing Address - Country:US
Mailing Address - Phone:810-667-5150
Mailing Address - Fax:810-667-6334
Practice Address - Street 1:3273 DAVISON RD
Practice Address - Street 2:SUITE #4
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2902
Practice Address - Country:US
Practice Address - Phone:810-667-5150
Practice Address - Fax:810-667-6334
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008436208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM79420001Medicare PIN
MIF00573Medicare UPIN