Provider Demographics
NPI:1104962174
Name:STEFFAN, PAUL EDWARD (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:STEFFAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33090 JANET
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-1727
Mailing Address - Country:US
Mailing Address - Phone:586-294-5609
Mailing Address - Fax:
Practice Address - Street 1:44300 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1003
Practice Address - Country:US
Practice Address - Phone:248-964-0400
Practice Address - Fax:248-964-0401
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4639015Medicaid
MIOF37078067Medicare ID - Type Unspecified
I16107Medicare UPIN