Provider Demographics
NPI:1891237103
Name:MICHAEL, STEPHEN A
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:A
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N MCKENZIE ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2326
Mailing Address - Country:US
Mailing Address - Phone:251-943-4395
Mailing Address - Fax:251-943-4209
Practice Address - Street 1:1805 N MCKENZIE ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2326
Practice Address - Country:US
Practice Address - Phone:251-943-4395
Practice Address - Fax:251-943-4209
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL162884156FX1800X
AL2211237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician