Provider Demographics
NPI:1205580669
Name:STEFAN, ROBERT ANDREW
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANDREW
Last Name:STEFAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28718 QUARRY CT
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2721
Mailing Address - Country:US
Mailing Address - Phone:248-320-4423
Mailing Address - Fax:
Practice Address - Street 1:38300 VAN DYKE AVE STE 102
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-1176
Practice Address - Country:US
Practice Address - Phone:586-275-0422
Practice Address - Fax:586-722-7917
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI21112130424183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist