Basic Information
| Provider Information | |||||||||
| NPI: | 1871540039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEWARD | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4967 CROOKS RD | ||||||||
| Address2: | STE. 130 | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480985801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489521601 | ||||||||
| FaxNumber: | 2489521614 | ||||||||
| Practice Location | |||||||||
| Address1: | 4967 CROOKS RD | ||||||||
| Address2: | STE. 130 | ||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480985801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489521601 | ||||||||
| FaxNumber: | 2489521614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35084295 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 4301091575 | MI | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1871540039 | 05 | MI | MEDICAID |