Provider Demographics
NPI:1851577316
Name:STEPHENS, LEO PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:PATRICK
Last Name:STEPHENS
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 1:25631 LITTLE MACK AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2100
Mailing Address - Country:US
Mailing Address - Phone:586-777-5090
Mailing Address - Fax:586-777-3111
Practice Address - Street 1:25631 LITTLE MACK AVE
Practice Address - Street 2:STE 202
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2100
Practice Address - Country:US
Practice Address - Phone:586-777-5090
Practice Address - Fax:586-777-3111
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030344207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN34900001Medicare PIN
MIA76900Medicare UPIN