Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 129788 | CA |
Y | 207X00000X | Orthopaedic Surgeon | 4301117356 | MI |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 4301117356 | MI |
NPI | 1346477676 |
---|---|
Provider Name | Matthew Thomas Stepanovich |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2009 |
Last Update Date | 25/02/2020 |