Individual
DR. JORDAN LEE STAV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11800 E 12 MILE RD, WARREN, MI 48093-3472
(586) 573-5000
Mailing address
11800 E 12 MILE RD, WARREN, MI 48093-3472
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301506040
MI
Other
Enumeration date
05/07/2019
Last updated
05/03/2022
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