Provider Demographics
NPI:1609926138
Name:STEPHAN, ELENA MICHAELA (MD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:MICHAELA
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 BENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3302
Mailing Address - Country:US
Mailing Address - Phone:248-856-6600
Mailing Address - Fax:248-856-6601
Practice Address - Street 1:75 BARCLAY CIR
Practice Address - Street 2:SUITE 230
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5820
Practice Address - Country:US
Practice Address - Phone:248-856-6600
Practice Address - Fax:248-856-6601
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063530207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG59350Medicare UPIN
MI110209878Medicare ID - Type Unspecified