Provider Demographics
NPI:1962703694
Name:STEPHEN SLAJUS DO PC
Entity type:Organization
Organization Name:STEPHEN SLAJUS DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SLAJUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:906-779-9870
Mailing Address - Street 1:1711 S STEPHENSON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3639
Mailing Address - Country:US
Mailing Address - Phone:906-779-9870
Mailing Address - Fax:906-779-5888
Practice Address - Street 1:1711 S STEPHENSON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3639
Practice Address - Country:US
Practice Address - Phone:906-779-9870
Practice Address - Fax:906-779-5888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009759207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30052700Medicaid
MI205220004OtherBLUE CROSS MICHIGAN
MI3011680Medicaid
MI3011680Medicaid
MI5220004Medicare PIN
MI0802290001Medicare NSC