Provider Demographics
NPI:1316557366
Name:STELLEMA, ELIZABETH J (NP-C)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:J
Last Name:STELLEMA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24396 KNOLLWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2632
Mailing Address - Country:US
Mailing Address - Phone:248-347-9437
Mailing Address - Fax:
Practice Address - Street 1:30800 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4542
Practice Address - Country:US
Practice Address - Phone:248-347-9437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1629011572207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine