Provider Demographics
NPI:1184682767
Name:STONEBROOKE FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:STONEBROOKE FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BELLISARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-997-9700
Mailing Address - Street 1:2940 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3609
Mailing Address - Country:US
Mailing Address - Phone:248-997-9700
Mailing Address - Fax:248-997-9710
Practice Address - Street 1:2940 CROOKS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3609
Practice Address - Country:US
Practice Address - Phone:248-997-9700
Practice Address - Fax:248-997-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F31854Medicare UPIN
0N22160Medicare PIN