Basic Information
| Provider Information | |||||||||
| NPI: | 1881892388 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAY | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | MARIE-COHEN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4660 SOUTH HAGADORN ROAD | ||||||||
| Address2: | SUITE #600 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5178842976 | ||||||||
| FaxNumber: | 5174323928 | ||||||||
| Practice Location | |||||||||
| Address1: | 4660 S HAGADORN RD STE 600 | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172672460 | ||||||||
| FaxNumber: | 5178848602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2007 | ||||||||
| LastUpdateDate: | 04/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 4301113538 | MI | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 208600000X | 4301113538 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0122X | 4301113538 | MI | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1881892388 | 05 | MI | MEDICAID |