Provider Demographics
NPI:1194738773
Name:STEVENS, RAYMOND JR (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:STEVENS
Suffix:JR
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 1:940 W AVON
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-652-6700
Mailing Address - Fax:248-652-6811
Practice Address - Street 1:940 W AVON
Practice Address - Street 2:SUITE 7
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-652-6700
Practice Address - Fax:248-652-6811
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRS035182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B46678Medicare UPIN
0P55330Medicare PIN