Individual
STEPHEN V HEADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3283 WILLOWCREEK RD, PORTAGE, IN 46368-5054
(219) 764-8439
(219) 764-8463
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02005477A
IN
207Q00000X
Family Medicine Physician
036105186
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105186
—
IL
Enumeration date
10/13/2006
Last updated
04/18/2023
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