Individual
MYRON B STACHNIW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6000 N ALLEN RD, PEORIA, IL 61614-3294
(309) 691-1400
(309) 693-3197
Mailing address
6000 N ALLEN RD, PEORIA, IL 61614-3294
(309) 691-1400
(309) 693-3197
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
036049846
IL
207X00000X
Orthopaedic Surgery Physician
Primary
036049846
IL
207X00000X
Orthopaedic Surgery Physician
36049846
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036049846
—
IL
Enumeration date
09/02/2005
Last updated
08/01/2022
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