Provider Demographics
NPI:1720280464
Name:DR STEPHEN D SENECOFF MD PC
Entity type:Organization
Organization Name:DR STEPHEN D SENECOFF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SENECOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-539-9450
Mailing Address - Street 1:30500 NORTHWESTERN HWY
Mailing Address - Street 2:STE 316
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3159
Mailing Address - Country:US
Mailing Address - Phone:248-539-9450
Mailing Address - Fax:248-539-9457
Practice Address - Street 1:30500 NORTHWESTERN HWY
Practice Address - Street 2:STE 316
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3159
Practice Address - Country:US
Practice Address - Phone:248-539-9450
Practice Address - Fax:248-539-9457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0637924OtherBLUE CROSS BLUE SHIELD
MI0P31200Medicare ID - Type Unspecified