Provider Demographics
NPI:1932257250
Name:WOODFIN, STEPHANIE M (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:M
Last Name:WOODFIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:121 S GARFIELD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-2967
Mailing Address - Country:US
Mailing Address - Phone:231-943-2328
Mailing Address - Fax:231-943-2327
Practice Address - Street 1:121 S GARFIELD AVE
Practice Address - Street 2:STE A
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2967
Practice Address - Country:US
Practice Address - Phone:231-943-2328
Practice Address - Fax:231-943-2327
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A90022084P0800X
MI51010190472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW6164KOtherMEDICARE GROUP
MIMI6285Medicare PIN