Provider Demographics
NPI:1427056118
Name:STAGEMAN, DONALD LEROY (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:LEROY
Last Name:STAGEMAN
Suffix:
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 1:926 S WASHINGTON AVE
Mailing Address - Street 2:BLDG D STE 230
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7725
Mailing Address - Country:US
Mailing Address - Phone:616-396-3544
Mailing Address - Fax:616-396-3548
Practice Address - Street 1:926 S WASHINGTON AVE
Practice Address - Street 2:BLDG D STE 230
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7725
Practice Address - Country:US
Practice Address - Phone:616-396-3544
Practice Address - Fax:616-396-3548
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039644207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4829459Medicaid
MI4829459Medicaid