1255300075 NPI number — DR. SHELDON L STERN DO

Table of content: DR. SHELDON L STERN DO (NPI 1255300075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255300075 NPI number — DR. SHELDON L STERN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STERN
Provider First Name:
SHELDON
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255300075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27275 HAGGERTY RD STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48377-3635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-741-6901
Provider Business Mailing Address Fax Number:
248-513-4320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23133 ORCHARD LAKE RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48336-3278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-476-2420
Provider Business Practice Location Address Fax Number:
248-478-7680
Provider Enumeration Date:
03/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  SS009136 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 080028850 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C3314 . This is a "MCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5630136 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 103553 . This is a "PREFERRED CHOICES CARE CH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1948296 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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