Provider Demographics
NPI:1922097542
Name:HADESMAN, STEVEN P (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:HADESMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2800 LIVERNOIS RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1215
Mailing Address - Country:US
Mailing Address - Phone:248-680-8208
Mailing Address - Fax:248-680-8208
Practice Address - Street 1:7633 E JEFFERSON AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3730
Practice Address - Country:US
Practice Address - Phone:313-499-4890
Practice Address - Fax:313-499-4945
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2016-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301045851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H208910OtherBLUE CROSS
MIN71840017OtherMEDICARE ID
MIN71840017OtherMEDICARE ID
MIB43981Medicare UPIN
MIN71840017OtherMEDICARE ID
MI1786527Medicaid
MI4945411Medicaid
MIM71670164Medicare PIN
N71840017Medicare ID - Type Unspecified