Provider Demographics
NPI:1992795181
Name:NEDELEA, STEFAN (PT)
Entity type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:
Last Name:NEDELEA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:STEFAN
Other - Middle Name:
Other - Last Name:NEDELEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:36880 WOODWARD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-0919
Mailing Address - Country:US
Mailing Address - Phone:248-593-8677
Mailing Address - Fax:248-593-8683
Practice Address - Street 1:36880 WOODWARD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0919
Practice Address - Country:US
Practice Address - Phone:248-593-8677
Practice Address - Fax:248-593-8683
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISN008896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650F335540OtherBCBS
MI0P38940Medicare PIN
MI650F335540OtherBCBS