Provider Demographics
NPI:1528033990
Name:DEROOS, STEVEN T (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:T
Last Name:DEROOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 MICHIGAN ST NE
Practice Address - Street 2:STE. 3003
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2514
Practice Address - Country:US
Practice Address - Phone:616-267-2500
Practice Address - Fax:616-267-2501
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010755022084N0402X, 2080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350D176310OtherBCBS GROUP #
MID16084082Medicare ID - Type Unspecified
MI1558407189OtherGROUP NPI
MI0M74460550Medicare PIN
MI4339331Medicaid