Provider Demographics
NPI:1447266945
Name:STEFANI, WILLIAM A (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:STEFANI
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 1:85 E BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1262
Mailing Address - Country:US
Mailing Address - Phone:586-779-3030
Mailing Address - Fax:586-779-6733
Practice Address - Street 1:85 E BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1262
Practice Address - Country:US
Practice Address - Phone:586-779-3030
Practice Address - Fax:586-779-6733
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301406868208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F75417Medicare UPIN
OM03670Medicare ID - Type Unspecified