Basic Information
| Provider Information | |||||||||
| NPI: | 1376509158 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINSTON | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5555 GLENWOOD HILLS PKWY SE STE 2 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495122091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169402662 | ||||||||
| FaxNumber: | 6169401965 | ||||||||
| Practice Location | |||||||||
| Address1: | 2060 EAST PARIS AVE SE STE 200 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495466113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162851377 | ||||||||
| FaxNumber: | 6162851154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 05/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 4301052549 | MI | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0014X | 4301052549 | MI | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 175881 | 01 | US DEPT OF LABOR | OTHER | 24278 | 01 | HEALTH PLAN OF MICHIGAN | OTHER | 4467217 | 01 | AETNA | OTHER | 4532369-10 | 05 | MI | MEDICAID | 550410620 | 01 | MI | BCBSM | OTHER | 504646 | 01 | PREFERRED CHOICES | OTHER | 5211643-10 | 05 | MI | MEDICAID | 7000027111 | 01 | PRIORITY HEALTH | OTHER | 050059838 | 01 | RAILROAD MEDICARE | OTHER | 4552960-10 | 05 | MI | MEDICAID | 3240684 | 01 | CIGNA | OTHER | 4593079-10 | 05 | MI | MEDICAID | 7000027111 | 01 | PRIORITY HEALTH MEDICAID | OTHER |