Provider Demographics
NPI:1639111966
Name:DEFRIEZ, STEPHEN D (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:DEFRIEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S BALLENGER HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3641
Mailing Address - Country:US
Mailing Address - Phone:810-342-4800
Mailing Address - Fax:
Practice Address - Street 1:501 S BALLENGER HWY
Practice Address - Street 2:SUITE B
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3641
Practice Address - Country:US
Practice Address - Phone:810-342-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022077522085R0202X
MI51010145312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI300B560780OtherBCBS
MI4767650Medicaid