Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 5901002115 | MI |
N | 213ES0103X | Foot & Ankle Surgery | PO3064 | FL |
NPI | 1053399949 |
---|---|
Provider Name | Dr. Stacey Ann Stefansky |
First Address | Southfield, MI 48075 |
Second Address | Livonia, MI 48150-3058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 01/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U95994 | (02) | FL |