Provider Demographics
NPI:1922097542
Name:HADESMAN, STEVEN P (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:HADESMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 LIVERNOIS RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1215
Mailing Address - Country:US
Mailing Address - Phone:248-680-8208
Mailing Address - Fax:248-680-8208
Practice Address - Street 1:30055 NORTHWESTERN HWY STE 160
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3211
Practice Address - Country:US
Practice Address - Phone:248-865-4150
Practice Address - Fax:248-865-4161
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301045851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H208910OtherBLUE CROSS
MIN71840017OtherMEDICARE ID
1922063213OtherNPI
MIB43981Medicare UPIN
MIN71840017OtherMEDICARE ID
MI1786527Medicaid
MI4945411Medicaid
MIM71670164Medicare PIN
N71840017Medicare ID - Type Unspecified