Provider Demographics
NPI:1528121738
Name:STAHL, ELIZABETH (DPM)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:STAHL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-3395
Mailing Address - Country:US
Mailing Address - Phone:248-414-5405
Mailing Address - Fax:
Practice Address - Street 1:1473 STEWART AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-3395
Practice Address - Country:US
Practice Address - Phone:248-414-5405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIES001916213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4951437OtherMEDICAID
MI4858111520OtherBCBSM
4858215760OtherBLUE CROSS
MIU73533Medicare UPIN
4858215760OtherBLUE CROSS
MI0M76900Medicare ID - Type Unspecified