Provider Demographics
NPI:1013949650
Name:PODOLSKY, STEVEN OWEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:OWEN
Last Name:PODOLSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1201 SOUTH DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3256
Mailing Address - Country:US
Mailing Address - Phone:989-773-3411
Mailing Address - Fax:989-775-3187
Practice Address - Street 1:1201 SOUTH DR
Practice Address - Street 2:SUITE 220
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3256
Practice Address - Country:US
Practice Address - Phone:989-773-3411
Practice Address - Fax:989-775-3187
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MISP064843207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104353850Medicaid
MI160C71016OtherBCBS GROUP#
MIN40240001Medicare ID - Type Unspecified
MIF56197Medicare UPIN