Provider Demographics
NPI:1457301780
Name:LESSENS, STEVEN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RICHARD
Last Name:LESSENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 BEVIER ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MI
Mailing Address - Zip Code:49455-1239
Mailing Address - Country:US
Mailing Address - Phone:231-861-2187
Mailing Address - Fax:231-861-5100
Practice Address - Street 1:71 BEVIER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MI
Practice Address - Zip Code:49455-1239
Practice Address - Country:US
Practice Address - Phone:231-861-2187
Practice Address - Fax:231-861-5100
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI042538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISL045238OtherSTATE LICENSE
MI1588709Medicaid
MI1588709Medicaid
MI0640002Medicare PIN