Basic Information
| Provider Information | |||||||||
| NPI: | 1356555916 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STEPHEN | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | HAMEED | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8244 METRO PARKWAY | ||||||||
| Address2: | SUITE C | ||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867954060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 27450 SCHOENHERR RD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480886683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344640887 | ||||||||
| FaxNumber: | 7344020254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 03/31/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301088367 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 700E012740 | 01 | MI | BCBS GROUP PIN | OTHER |