Provider Demographics
NPI:1679649768
Name:STEHOUWER, EDWARD JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:STEHOUWER
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 1:1675 LEAHY STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5543
Mailing Address - Country:US
Mailing Address - Phone:231-728-5567
Mailing Address - Fax:231-725-7134
Practice Address - Street 1:1675 LEAHY STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5543
Practice Address - Country:US
Practice Address - Phone:231-728-5567
Practice Address - Fax:231-725-7134
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI38469208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2806100372OtherBLUE CROSS BLUE SHIELD OF
MI1892664Medicaid
2806100372OtherBLUE CARE NETWORK
2806100372OtherBLUE CHOICE
2806100372OtherBLUE CARE NETWORK
E25837Medicare UPIN