Provider Demographics
NPI:1265472328
Name:MCMAHON, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 KALAMAZOO AVE SE STE A
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9197
Mailing Address - Country:US
Mailing Address - Phone:616-818-7454
Mailing Address - Fax:616-818-7455
Practice Address - Street 1:7150 KALAMAZOO AVE SE STE A
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-9197
Practice Address - Country:US
Practice Address - Phone:616-818-7454
Practice Address - Fax:616-818-7455
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069699208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D16150061Medicare ID - Type Unspecified
MI0M74460251Medicare PIN
G83226Medicare UPIN