Provider Demographics
NPI:1710340997
Name:STEPHAN, CRAIG (CP)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:STEPHAN
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23778 CAYUGA AVE
Mailing Address - Street 2:
Mailing Address - City:HAZEL PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48030-2706
Mailing Address - Country:US
Mailing Address - Phone:810-874-1452
Mailing Address - Fax:
Practice Address - Street 1:1901 BRUNSWICK AVE STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-2809
Practice Address - Country:US
Practice Address - Phone:704-348-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management