Provider Demographics
NPI:1932198793
Name:STEVENS, MICHAEL POPKIN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:POPKIN
Last Name:STEVENS
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 1:101 S SAN MATEO DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3819
Mailing Address - Country:US
Mailing Address - Phone:650-348-6011
Mailing Address - Fax:650-348-6027
Practice Address - Street 1:101 S SAN MATEO DR
Practice Address - Street 2:SUITE 307
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3819
Practice Address - Country:US
Practice Address - Phone:650-348-6011
Practice Address - Fax:650-348-6027
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59207207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G592070Medicaid
CAF10733Medicare UPIN
CA00G592070Medicare ID - Type Unspecified