Provider Demographics
NPI:1326045659
Name:BISHOP, STEPHEN WILLARD (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WILLARD
Last Name:BISHOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9912 E GRAND RIVER AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1973
Mailing Address - Country:US
Mailing Address - Phone:810-588-4214
Mailing Address - Fax:810-588-4353
Practice Address - Street 1:9912 E GRAND RIVER AVE STE 1000
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1973
Practice Address - Country:US
Practice Address - Phone:810-588-4214
Practice Address - Fax:810-588-4353
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301047475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5046170OtherAETNA
MI785500OtherFIRST HEALTH
MIP00221534OtherRAILROAD MEDICARE
MI3186078Medicaid
MI4561450Medicaid
MI108045OtherPRIORITY HEALTH
MI147144OtherGREAT LAKES HEALTH PLAN
MI665-1OtherTOTAL HEALTH CARE
MI080H215880OtherBCBS & BCN
MI665-1OtherTOTAL HEALTH CARE
MIP00221534OtherRAILROAD MEDICARE