Basic Information
| Provider Information | |||||||||
| NPI: | 1982138442 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPADAFORE | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 N INGALLS ST BLDG NI4E10A | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481090400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342326776 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2951 EARHART RD | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481059728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346475640 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2017 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301505444 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 4351045878 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 390200000X | 4351045878 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207QS0010X | 4301505444 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.