Provider Demographics
NPI:1316913270
Name:STEFADU, YEVGENIY G (MD, PHD)
Entity type:Individual
Prefix:
First Name:YEVGENIY
Middle Name:G
Last Name:STEFADU
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 CROWFOOT DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4095
Mailing Address - Country:US
Mailing Address - Phone:248-709-6158
Mailing Address - Fax:586-268-5818
Practice Address - Street 1:3058 METROPOLITAN PKWY
Practice Address - Street 2:#108
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3671
Practice Address - Country:US
Practice Address - Phone:586-268-0100
Practice Address - Fax:586-268-5818
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2012-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074792207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316913270Medicaid
H20005Medicare UPIN
MIG46040053Medicare PIN