Basic Information
| Provider Information | |||||||||
| NPI: | 1780067694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STIEG | ||||||||
| FirstName: | GRETCHEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4160 JOHN R ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137457514 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4160 JOHN R ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137457514 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2015 | ||||||||
| LastUpdateDate: | 06/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4301502703 | MI | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | TRN21711 | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.