Provider Demographics
NPI:1962676783
Name:MICHIGAN INFERTILITY CENTER PC
Entity Type:Organization
Organization Name:MICHIGAN INFERTILITY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:248-647-5565
Mailing Address - Street 1:189 TOWNSEND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6008
Mailing Address - Country:US
Mailing Address - Phone:248-647-5565
Mailing Address - Fax:248-647-0685
Practice Address - Street 1:189 TOWNSEND ST
Practice Address - Street 2:STE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6008
Practice Address - Country:US
Practice Address - Phone:248-647-5565
Practice Address - Fax:248-647-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWS024907174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1606384752OtherBCBS
MI0638475Medicare PIN