Organization
STACEY STEFANSKY DPM PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY STEFANSKY DPM (OWNER)
(248) 390-5730
Entity
Organization
Contact information
Practice address
2130 MARSHALL COURT, WATERFORD, MI 48329-4069
(248) 390-5730
Mailing address
PO BOX 300965, DRAYTON PLAINS, MI 48330-0965
(248) 390-5730
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
5901002115
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053399949
—
MI
01
—
4856320100
BLUE CROSS BLUE SHIELD
MI
Enumeration date
02/10/2009
Last updated
07/23/2019
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