Provider Demographics
NPI:1891760971
Name:STEPHENS, KENNETH E (DO)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 W LAKE LANSING RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6371
Mailing Address - Country:US
Mailing Address - Phone:517-333-3777
Mailing Address - Fax:517-203-3956
Practice Address - Street 1:830 W LAKE LANSING RD
Practice Address - Street 2:SUITE 190
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6371
Practice Address - Country:US
Practice Address - Phone:517-333-3777
Practice Address - Fax:517-203-3956
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010508207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI300040412OtherTRICARE
MI1017937OtherMCLAREN HEALTH ADVANTAGE
MI200C313650OtherBLUECARE NETWORK
MI4838574Medicaid
MI200000001155OtherPHYSICIANS HEALTH PLAN
MI0970031OtherPHP-FAMILY CARE
MI200C313650OtherBCBS MI
MI200000001155OtherPHYSICIANS HEALTH PLAN
MIP26020003Medicare ID - Type Unspecified