Provider Demographics
NPI:1245266220
Name:STEVELINCK, JOHN M (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:STEVELINCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 BYRON RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1410
Mailing Address - Country:US
Mailing Address - Phone:517-548-3100
Mailing Address - Fax:517-548-4594
Practice Address - Street 1:524 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1410
Practice Address - Country:US
Practice Address - Phone:517-548-3100
Practice Address - Fax:517-548-4594
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001979213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D70553OtherBCBSM GROUP
MI4996279Medicaid
MI4854713560OtherBCBSM INDIVIDUAL PIN
MI480D710100OtherBCBSM GROUP
MI480D710100OtherBCBSM GROUP
MIU81662Medicare UPIN