Provider Demographics
NPI:1801997952
Name:STEPHEN C. DALM DO PC
Entity type:Organization
Organization Name:STEPHEN C. DALM DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:DALM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-247-1700
Mailing Address - Street 1:5060 CASCADE RD SE
Mailing Address - Street 2:STE C
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3808
Mailing Address - Country:US
Mailing Address - Phone:616-247-1700
Mailing Address - Fax:616-247-3679
Practice Address - Street 1:5060 CASCADE RD SE
Practice Address - Street 2:STE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3808
Practice Address - Country:US
Practice Address - Phone:616-247-1700
Practice Address - Fax:616-247-3679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI008560207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160D110280OtherBLUE CROSS BLUE SHIELD
MI2739380Medicaid
MI2739380Medicaid
MI5410203Medicare ID - Type Unspecified
OP57880Medicare PIN