Provider Demographics
NPI:1427579929
Name:ALBERTSON, STETSON (DO)
Entity Type:Individual
Prefix:
First Name:STETSON
Middle Name:
Last Name:ALBERTSON
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 1:13450 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3671
Mailing Address - Country:US
Mailing Address - Phone:586-759-5525
Mailing Address - Fax:
Practice Address - Street 1:13450 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3671
Practice Address - Country:US
Practice Address - Phone:586-759-5525
Practice Address - Fax:586-759-4022
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151010686390200000X
MI5101023631390200000X
MI5101024479207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program