Provider Demographics
NPI:1457393514
Name:STANLEY, ADRIENNE M (DO)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:M
Last Name:STANLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ADRIENNE
Other - Middle Name:M
Other - Last Name:PAESANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:28711 8 MILE RD
Mailing Address - Street 2:C/O COMPREHENSIVE OBGYN
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2041
Mailing Address - Country:US
Mailing Address - Phone:248-474-4590
Mailing Address - Fax:248-888-9127
Practice Address - Street 1:28711 8 MILE RD
Practice Address - Street 2:C/O COMPREHENSIVE OBGYN
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2040
Practice Address - Country:US
Practice Address - Phone:248-474-4590
Practice Address - Fax:248-888-9127
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013976207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4732646Medicaid
MI1658212135OtherBLUE CROSS ID
MI4732655Medicaid
MI16903OtherMCARE ID
MI7729497OtherAETNA ID
MI140563OtherCARE CHOICES
MI7729497OtherAETNA ID
H94079Medicare UPIN
MI140563OtherCARE CHOICES