Provider Demographics
NPI:1215081500
Name:JEFFREY A, STICKNEY,D.O. P C
Entity type:Organization
Organization Name:JEFFREY A, STICKNEY,D.O. P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:STICKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-423-3901
Mailing Address - Street 1:5449 S OCCIDENTAL RD
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-9782
Mailing Address - Country:US
Mailing Address - Phone:517-423-3901
Mailing Address - Fax:
Practice Address - Street 1:5449 S OCCIDENTAL RD
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-9782
Practice Address - Country:US
Practice Address - Phone:517-423-3901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION95690Medicare ID - Type Unspecified