Provider Demographics
NPI:1053399949
Name:STEFANSKY, STACEY ANN (DPM)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:ANN
Last Name:STEFANSKY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22250 PROVIDENCE DRIVE
Mailing Address - Street 2:SUITE 608 FOOT AND HEEL PAIN INSTITUTE OF MICHIGAN
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-557-6500
Mailing Address - Fax:248-557-2781
Practice Address - Street 1:10986 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3058
Practice Address - Country:US
Practice Address - Phone:734-261-3400
Practice Address - Fax:734-261-3411
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3064213ES0103X
MI5901002115213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593578763OtherGROUP TAX ID NUMBER
FLU95994Medicare UPIN
FL593578763OtherGROUP TAX ID NUMBER