Provider Demographics
NPI:1346246337
Name:STEVENS, JULIE M (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:M
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9511 S CRAWFORD RD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:MI
Mailing Address - Zip Code:48883-8504
Mailing Address - Country:US
Mailing Address - Phone:989-828-5763
Mailing Address - Fax:
Practice Address - Street 1:416 N MISSION
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-773-3789
Practice Address - Fax:989-773-6677
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS013404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4435777 TYPE 11Medicaid
0N56990Medicare ID - Type Unspecified