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Individual

MR. STANLEY M. MICHELCAVAGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
2601 ELECTRIC AVE, PORT HURON, MI 48060-6587
(810) 985-1500
(810) 966-3104
Mailing address
2614 FARMDALE DR, STERLING HEIGHTS, MI 48314-3868

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704151696
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
425219610
MI
01
P100918
BCN
MI
01
SM151696
BLUE CROSS
MI
Enumeration date
09/26/2006
Last updated
07/08/2007
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