Provider Demographics
NPI:1780642058
Name:FREY, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:FREY
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 1:301 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:MI
Mailing Address - Zip Code:48884-9235
Mailing Address - Country:US
Mailing Address - Phone:989-291-3261
Mailing Address - Fax:989-291-6121
Practice Address - Street 1:301 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MI
Practice Address - Zip Code:48884-9235
Practice Address - Country:US
Practice Address - Phone:989-291-3261
Practice Address - Fax:989-291-6121
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050363207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI105177908Medicaid
MI0F71000OtherBCBS
MI104400118Medicaid
MI104744754Medicaid
MI104134512Medicaid
MI104134512Medicaid
MI105177908Medicaid
MI104400118Medicaid
MI104744754Medicaid