Individual
DR. STEPHEN DALE BOVENKERK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2151 W SPRING ST STE B120, MONROE, GA 30655-3210
(770) 207-0215
Mailing address
2680 S CLEVELAND AVE, SAINT JOSEPH, MI 49085-3002
(269) 982-3368
(269) 983-3238
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
82870
GA
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
5101015878
MI
Other
Enumeration date
04/03/2007
Last updated
09/27/2022
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