Provider Demographics
NPI:1922084896
Name:STERN, MILTON (DO)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:
Last Name:STERN
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 1:6149 N WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7128
Mailing Address - Country:US
Mailing Address - Phone:734-728-2130
Mailing Address - Fax:734-728-2626
Practice Address - Street 1:6149 N WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7128
Practice Address - Country:US
Practice Address - Phone:734-728-2130
Practice Address - Fax:734-728-2626
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006345208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0856330534OtherBCBS INDIVIDUAL
MI700H219150OtherBLUE SHIELD
MI1922084896Medicaid
MIP00129465OtherRR MEDICARE
MIP00129465OtherRR MEDICARE
MI0N47600017Medicare PIN