Provider Demographics
NPI:1831127463
Name:STEPHENS, DANIEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3950 HOLLYWOOD ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ST JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085
Mailing Address - Country:US
Mailing Address - Phone:269-429-0900
Mailing Address - Fax:269-408-0996
Practice Address - Street 1:3950 HOLLYWOOD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9151
Practice Address - Country:US
Practice Address - Phone:269-429-0900
Practice Address - Fax:269-408-0996
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
MI4301404254208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI27-0381199OtherGROUP TAX ID
MI1538397120OtherGROUP NPI
MI0201109862OtherBLUE CROSS PIN
MI1831127463Medicaid
MIMI2051OtherGROUP MEDICARE PTAN
MIMI2051OtherGROUP MEDICARE PTAN
MI0201109862OtherBLUE CROSS PIN
MIMI2051111Medicare PIN