Provider Demographics
NPI:1700825288
Name:DORFMAN, STANLEY A (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:A
Last Name:DORFMAN
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:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48303-0187
Mailing Address - Country:US
Mailing Address - Phone:248-338-0100
Mailing Address - Fax:248-858-3959
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-338-0100
Practice Address - Fax:248-858-3959
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301029359207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC4203OtherMCARE
MI160F36364OtherBCBS GROUP
MI0004278388OtherAETNA
MI0F36364OtherMEDICARE GROUP
MI0004278388OtherAETNA