Basic Information
| Provider Information | |||||||||
| NPI: | 1487642575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONHON | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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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: | 10090 E LIPPINCOTT BLVD | ||||||||
| Address2: | |||||||||
| City: | DAVISON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484239151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106581130 | ||||||||
| FaxNumber: | 8106588589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| 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 | 4301069918 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 253092 | 01 | MI | HEALTH ADVANTAGE NETWORK | OTHER | 0988440 | 01 | MI | HEALTH PLUS OF MI | OTHER | H17587 | 01 | MI | HEALTH ALLIANCE PLAN | OTHER | 4255705 | 05 | MI | MEDICAID | 7738126 | 01 | MI | AETNA | OTHER | C7601 | 01 | MI | MCARE | OTHER | 0802505252 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 253092 | 01 | MI | MCLAREN HEALTH PLAN | OTHER |