Provider Demographics
NPI:1982802245
Name:CETNER, AARON STUART (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:STUART
Last Name:CETNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2051 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-1865
Mailing Address - Country:US
Mailing Address - Phone:815-741-4343
Mailing Address - Fax:815-741-8660
Practice Address - Street 1:6330 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2398
Practice Address - Country:US
Practice Address - Phone:248-694-6390
Practice Address - Fax:248-694-6391
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAC093636207ND0101X
IL036.118454207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL974040Medicare PIN
MIF37225006Medicare PIN