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Individual

MICHAEL E STANIK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
811 AINSWORTH DR, SUITE 101, PRESCOTT, AZ 86301-1687
(928) 771-5282
(928) 771-5283
Mailing address
811 AINSWORTH DR, SUITE 101, PRESCOTT, AZ 86301-1687
(928) 771-5282
(928) 771-5283

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25078
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
861999
AZ
01
AZ0755280
BLUE CROSS/BLUE SHIELD
AZ
01
P00143552
RAILROAD MEDICARE
AZ
Enumeration date
06/21/2006
Last updated
06/24/2009
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