Provider Demographics
NPI:1235286055
Name:CLYNE, STEPHEN D (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:CLYNE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:44200 WOODWARD AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5045
Mailing Address - Country:US
Mailing Address - Phone:248-253-0330
Mailing Address - Fax:248-253-1982
Practice Address - Street 1:44200 WOODWARD AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5045
Practice Address - Country:US
Practice Address - Phone:248-253-0330
Practice Address - Fax:248-253-1982
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2009-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101015590207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I48327Medicare UPIN
M54550021Medicare PIN