Provider Demographics
NPI:1760579395
Name:STEVENSON, VERNON ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:ROY
Last Name:STEVENSON
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 1:1000 E STADIUM BLVD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4616
Mailing Address - Country:US
Mailing Address - Phone:734-769-3333
Mailing Address - Fax:734-769-6666
Practice Address - Street 1:1000 E STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4616
Practice Address - Country:US
Practice Address - Phone:734-769-3333
Practice Address - Fax:734-769-6666
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061583207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4517003Medicaid
MIP00049831OtherRAILROAD MEDICARE
MI0046188OtherCHAMPUS
MI1103810141OtherBCBS
MI1103810141OtherBCBS
MIG53709Medicare UPIN
MIP00049831OtherRAILROAD MEDICARE