Provider Demographics
NPI:1376509158
Name:WINSTON, STEPHEN LEE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEE
Last Name:WINSTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5555 GLENWOOD HILLS PKWY SE STE 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2091
Mailing Address - Country:US
Mailing Address - Phone:616-940-2662
Mailing Address - Fax:616-940-1965
Practice Address - Street 1:2060 EAST PARIS AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6113
Practice Address - Country:US
Practice Address - Phone:616-285-1377
Practice Address - Fax:616-285-1154
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301052549207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
175881OtherUS DEPT OF LABOR
24278OtherHEALTH PLAN OF MICHIGAN
4467217OtherAETNA
MI4532369-10Medicaid
MI550410620OtherBCBSM
504646OtherPREFERRED CHOICES
MI5211643-10Medicaid
7000027111OtherPRIORITY HEALTH
050059838OtherRAILROAD MEDICARE
MI4552960-10Medicaid
3240684OtherCIGNA
MI4593079-10Medicaid
7000027111OtherPRIORITY HEALTH MEDICAID
504646OtherPREFERRED CHOICES
MI4532369-10Medicaid