Provider Demographics
NPI:1407919202
Name:MESSANA, STEPHEN ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:MESSANA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 EMERALD PARK
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-6155
Mailing Address - Country:US
Mailing Address - Phone:989-498-4053
Mailing Address - Fax:989-498-4052
Practice Address - Street 1:2809 EMERALD PARK
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-6155
Practice Address - Country:US
Practice Address - Phone:989-498-4053
Practice Address - Fax:989-498-4052
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL7725202085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00300798OtherRAILROAD MEDICARE
MI4926274Medicaid
MI3157300774OtherBCBS OF MI
MIM21440050Medicare ID - Type Unspecified
MI3157300774OtherBCBS OF MI