Provider Demographics
NPI:1194961128
Name:STIDHAM STONE, STEVEN RICHARD (CMMT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:RICHARD
Last Name:STIDHAM STONE
Suffix:
Gender:M
Credentials:CMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13679 MARION RD
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616-8507
Mailing Address - Country:US
Mailing Address - Phone:386-569-8961
Mailing Address - Fax:
Practice Address - Street 1:1585 AMANDA DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7392
Practice Address - Country:US
Practice Address - Phone:989-792-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist