Provider Demographics
NPI:1932125838
Name:TERRIAN, STEVEN J (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:TERRIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1711 S STEPHENSON AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3637
Mailing Address - Country:US
Mailing Address - Phone:906-774-0330
Mailing Address - Fax:906-774-2584
Practice Address - Street 1:1711 S STEPHENSON AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3637
Practice Address - Country:US
Practice Address - Phone:906-774-0330
Practice Address - Fax:906-774-2584
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012687208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43492100Medicaid
MI4294955Medicaid
H21526Medicare UPIN
MIOB26000005Medicare ID - Type Unspecified