Provider Demographics
NPI:1285106070
Name:STEVENS, MICHAEL JONATHAN (PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JONATHAN
Last Name:STEVENS
Suffix:
Gender:
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:702-832-4562
Mailing Address - Fax:888-481-1462
Practice Address - Street 1:2335 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7141
Practice Address - Country:US
Practice Address - Phone:702-832-4562
Practice Address - Fax:888-481-1462
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA2069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine