Provider Demographics
NPI:1508880428
Name:ARONSSON, STIG E (MD)
Entity Type:Individual
Prefix:
First Name:STIG
Middle Name:E
Last Name:ARONSSON
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 1:1695 W 12 MILE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-2100
Mailing Address - Country:US
Mailing Address - Phone:248-548-9090
Mailing Address - Fax:
Practice Address - Street 1:1695 W 12 MILE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-2100
Practice Address - Country:US
Practice Address - Phone:248-548-9090
Practice Address - Fax:248-548-8462
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301405984207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2819730Medicaid
MIA73966Medicare UPIN
MI2819730Medicaid