Provider Demographics
NPI:1437255833
Name:STEVENS, MICHAEL L (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:STEVENS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 CONSTITUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530
Mailing Address - Country:US
Mailing Address - Phone:610-683-5067
Mailing Address - Fax:610-683-3823
Practice Address - Street 1:91 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530
Practice Address - Country:US
Practice Address - Phone:610-683-5067
Practice Address - Fax:610-683-3823
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003061L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014586150003Medicaid
PA0014586150003Medicaid
T30753Medicare UPIN