Provider Demographics
NPI:1356400923
Name:PICARD, STEVEN WOODWARD (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WOODWARD
Last Name:PICARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 S ROSS ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:MI
Mailing Address - Zip Code:48612-9101
Mailing Address - Country:US
Mailing Address - Phone:989-246-3500
Mailing Address - Fax:989-246-3519
Practice Address - Street 1:439 S ROSS ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:MI
Practice Address - Zip Code:48612-9101
Practice Address - Country:US
Practice Address - Phone:989-246-3500
Practice Address - Fax:989-246-3519
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISPO55283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3482001Medicaid
F85551Medicare UPIN
OM60470Medicare ID - Type Unspecified