Provider Demographics
NPI:1417083452
Name:DUGGAN, STEPHANIE JUISTER (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JUISTER
Last Name:DUGGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:JUISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2551
Mailing Address - Country:US
Mailing Address - Phone:989-907-8325
Mailing Address - Fax:989-776-1704
Practice Address - Street 1:800 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2551
Practice Address - Country:US
Practice Address - Phone:989-907-8325
Practice Address - Fax:989-776-1704
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063744207P00000X
FLME109177207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0033854-00Medicaid
FL14C03OtherBCBS FL
FL0033854-00Medicaid