1356455463 NPI number — MICHAEL J STADNYK M. D.

Table of content: MICHAEL J STADNYK M. D. (NPI 1356455463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356455463 NPI number — MICHAEL J STADNYK M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STADNYK
Provider First Name:
MICHAEL
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M. D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356455463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2153 DEPT 30755
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35287-9283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-238-5260
Provider Business Mailing Address Fax Number:
314-821-1833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 DOCTORS PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE GIRARDEAU
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63703-4928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-334-6071
Provider Business Practice Location Address Fax Number:
573-334-4739
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  103346 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 194361 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 58770V12822 . This is a "HEALTHCARE USA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 208094714 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27716 . This is a "GROUP HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00295078 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 332305 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3848 . This is a "CMR" identifier . This identifiers is of the category "OTHER".
  • Identifier: G32279 . This is a "MERCY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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