Provider Demographics
NPI:1538480223
Name:PETERSON, STEPHANIE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LYNN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10020 PROFESSIONAL CENTER DRIVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HAMBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48139
Mailing Address - Country:US
Mailing Address - Phone:810-231-0252
Mailing Address - Fax:810-231-0256
Practice Address - Street 1:10020 PROFESSIONAL CENTER DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:HAMBURG
Practice Address - State:MI
Practice Address - Zip Code:48139
Practice Address - Country:US
Practice Address - Phone:810-231-0252
Practice Address - Fax:810-231-0256
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1805043207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine