Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 4301056282 | MI |
NPI | 1033100219 |
---|---|
Provider Name | Dr. Melissa A Stevens |
First Address | Southfield, MI 48033-3849 |
Second Address | Royal Oak, MI 48073-6712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 23/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4187169 | (05) | MI |
G22930 | (02) |