Provider Demographics
NPI:1376534164
Name:TAIT, STEPHEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:TAIT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7575 GRAND RIVER RD STE 111
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-9390
Mailing Address - Country:US
Mailing Address - Phone:810-844-7744
Mailing Address - Fax:810-844-7725
Practice Address - Street 1:7575 GRAND RIVER RD STE 111
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9390
Practice Address - Country:US
Practice Address - Phone:810-844-7744
Practice Address - Fax:810-844-7725
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2024-03-19
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Provider Licenses
StateLicense IDTaxonomies
MI4301074678207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4528043Medicaid
MI0M88850Medicare UPIN