Provider Demographics
NPI:1801897814
Name:STOFFER, SHELDON SAUL (MD)
Entity type:Individual
Prefix:
First Name:SHELDON
Middle Name:SAUL
Last Name:STOFFER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:29355 NORTHWESTERN HWY
Mailing Address - Street 2:120
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 STEPHENSON HWY
Practice Address - Street 2:235 BBC
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1103
Practice Address - Country:US
Practice Address - Phone:248-577-3522
Practice Address - Fax:248-577-3526
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301026998207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI409490910Medicaid
MI409490910Medicaid
MI0F36477065Medicare ID - Type Unspecified