Provider Demographics
NPI:1134178551
Name:KRESHOVER, STEVEN MARK (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARK
Last Name:KRESHOVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:31500 TELEGRAPH RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4367
Mailing Address - Country:US
Mailing Address - Phone:248-647-1200
Mailing Address - Fax:248-647-1329
Practice Address - Street 1:31500 TELEGRAPH RD
Practice Address - Street 2:SUITE 215
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4367
Practice Address - Country:US
Practice Address - Phone:248-647-1200
Practice Address - Fax:248-647-1329
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2014-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301046958207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2735649Medicaid
MI2735649Medicaid
F06151Medicare UPIN