Provider Demographics
NPI:1992095467
Name:DONOVAN, STEPHANIE JILL (DPM)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:JILL
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:DPM
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Other - First Name:
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Mailing Address - Street 1:990 W ANN ARBOR TRL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-6204
Mailing Address - Country:US
Mailing Address - Phone:734-414-0874
Mailing Address - Fax:734-414-0875
Practice Address - Street 1:990 W ANN ARBOR TRL
Practice Address - Street 2:SUITE 200
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-6204
Practice Address - Country:US
Practice Address - Phone:734-414-0874
Practice Address - Fax:734-414-0875
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901002407213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP46030003Medicare PIN