Provider Demographics
NPI:1295725620
Name:CAHILL, STEPHEN DOUGLAS (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DOUGLAS
Last Name:CAHILL
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1000 HARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2920
Mailing Address - Country:US
Mailing Address - Phone:586-790-9003
Mailing Address - Fax:586-493-3603
Practice Address - Street 1:1030 HARRINGTON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2967
Practice Address - Country:US
Practice Address - Phone:586-466-6230
Practice Address - Fax:586-493-3828
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2018-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008358208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111886077Medicaid
MIA76592Medicare UPIN
MI111886077Medicaid