Provider Demographics
NPI:1245224583
Name:SWETECH, STEPHEN MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:SWETECH
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 1:43600 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1120
Mailing Address - Country:US
Mailing Address - Phone:586-228-0400
Mailing Address - Fax:586-228-9112
Practice Address - Street 1:43600 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1120
Practice Address - Country:US
Practice Address - Phone:586-228-0400
Practice Address - Fax:586-228-9112
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3493883Medicaid
MIOP16950Medicare PIN
E26776Medicare UPIN