Individual
MRS. STEPHANIE LYNN ILLIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 WILLIAM CARLS DR, STE 120, COMMERCE TOWNSHIP, MI 48382-2201
(248) 937-4947
Mailing address
16208 BALDWIN CIR, HOLLY, MI 48442-9384
(586) 215-3273
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601006316
MI
Other
Enumeration date
04/13/2012
Last updated
04/13/2012
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