Provider Demographics
NPI:1881892388
Name:BRAY, STEPHANIE MARIE-COHEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARIE-COHEN
Last Name:BRAY
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 1:4660 SOUTH HAGADORN ROAD
Mailing Address - Street 2:SUITE #600
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:4660 S HAGADORN RD STE 600
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5383
Practice Address - Country:US
Practice Address - Phone:517-267-2460
Practice Address - Fax:517-884-8602
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301113538208200000X, 208600000X, 2086S0122X, 2086S0122X
IN01076960A208600000X, 2086S0122X
KS94-06733208600000X
IL0361327162086S0122X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1881892388Medicaid