Basic Information
| Provider Information | |||||||||
| NPI: | 1104888163 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | FLOYD | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 1480 W CENTER RD | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | ESSEXVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487322143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898954625 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101005165 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1004143 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 1004143 | 01 | MI | HEALTH ADVANTAGE | OTHER | 3072649 | 05 | MI | MEDICAID | 0118935 | 01 | MI | HEALTHPLUS | OTHER | E25873 | 01 | MI | HEALTH NET FEDERAL SERVIC | OTHER | 0850918934 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER |