Provider Demographics
NPI:1932168044
Name:FLOM, STEPHANIE C (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:C
Last Name:FLOM
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 1:19714 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1064
Mailing Address - Country:US
Mailing Address - Phone:586-779-9400
Mailing Address - Fax:586-772-1440
Practice Address - Street 1:19714 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1064
Practice Address - Country:US
Practice Address - Phone:586-779-9400
Practice Address - Fax:586-772-1440
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063747207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3519406Medicaid
MI3519406Medicaid
E06199007Medicare ID - Type Unspecified