Provider Demographics
NPI:1487642575
Name:CONHON, STANLEY J (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:J
Last Name:CONHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:10090 E LIPPINCOTT BLVD
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-9151
Practice Address - Country:US
Practice Address - Phone:810-658-1130
Practice Address - Fax:810-658-8589
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301069918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI253092OtherHEALTH ADVANTAGE NETWORK
MI0988440OtherHEALTH PLUS OF MI
MIH17587OtherHEALTH ALLIANCE PLAN
MI4255705Medicaid
MI7738126OtherAETNA
MIC7601OtherMCARE
MI0802505252OtherBLUE CROSS BLUE SHIELD
MI253092OtherMCLAREN HEALTH PLAN
MI4255705Medicaid