Provider Demographics
NPI:1235121138
Name:PLOMARITIS, STEVEN T (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:T
Last Name:PLOMARITIS
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 1:28001 SCHOENHERR RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4396
Mailing Address - Country:US
Mailing Address - Phone:586-558-9500
Mailing Address - Fax:586-558-9501
Practice Address - Street 1:28001 SCHOENHERR RD
Practice Address - Street 2:SUITE 3
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4396
Practice Address - Country:US
Practice Address - Phone:586-558-9500
Practice Address - Fax:586-558-9501
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008748207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3013165Medicaid
MISP008748OtherBCBS PIN #
E26760Medicare UPIN
MISP008748OtherBCBS PIN #