Provider Demographics
NPI:1396892105
Name:STEFAN, NATALIE NAZARK (MD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:NAZARK
Last Name:STEFAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 AUTO CLUB DR
Mailing Address - Street 2:HENRY FORD HEALTH SYSTEM
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2683
Mailing Address - Country:US
Mailing Address - Phone:313-425-4700
Mailing Address - Fax:313-425-4700
Practice Address - Street 1:5500 AUTO CLUB DR
Practice Address - Street 2:HENRY FORD HEALTH SYSTEM
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2683
Practice Address - Country:US
Practice Address - Phone:313-425-4700
Practice Address - Fax:313-425-4700
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052279208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262280OtherBLUE CROSS-BLUE CROSS
NN052279OtherCOMMERCIAL-COMMERCIAL NUMBER
MINN052279OtherCHAMPUS, COMMERCIAL
MI191938310Medicaid
NN052279OtherCHAMPUS-CHAMPUS
NN052279OtherCHAMPUS-CHAMPUS
MIF01755Medicare UPIN
0H26228094Medicare ID - Type Unspecified