Provider Demographics
NPI:1013997477
Name:PRIEST, STEPHEN G (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:G
Last Name:PRIEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1121 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1301
Mailing Address - Country:US
Mailing Address - Phone:248-541-8554
Mailing Address - Fax:248-541-1791
Practice Address - Street 1:1121 CROOKS RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1301
Practice Address - Country:US
Practice Address - Phone:248-541-8554
Practice Address - Fax:248-541-1791
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301407240208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1815520Medicaid
MIOF36140Medicare PIN
B46711Medicare UPIN