Individual
TOM STATHAKIOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18101 OAKWOOD BLVD, DEARBORN, MI 48124-4089
(313) 436-2374
Mailing address
2 COLUMBIA DR, SUTIE A327, TAMPA, FL 33606-3508
(813) 844-4396
(813) 844-4972
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
058286
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050H26218
MI BCBS
FL
05
—
104156743
—
MI
01
—
P52260001
MIGTBA MEDICARE REASSIGN
MI
Enumeration date
11/17/2006
Last updated
03/17/2018
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