Provider Demographics
NPI:1447259056
Name:STUTZ, JOSEPH A (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:STUTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 W UNIVERSITY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6905
Mailing Address - Country:US
Mailing Address - Phone:248-651-9500
Mailing Address - Fax:248-651-3366
Practice Address - Street 1:919 W UNIVERSITY DR STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-6905
Practice Address - Country:US
Practice Address - Phone:248-651-9500
Practice Address - Fax:248-651-3366
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068458207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4114411Medicaid
G91643Medicare UPIN
MI4114411Medicaid