Individual
DR. PAUL J STANISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 S LAKE PARK AVE, STE 200, HOBART, IN 46342-6791
(219) 947-6122
(219) 947-6045
Mailing address
1400 S LAKE PARK AVE, STE 200, HOBART, IN 46342-6791
(219) 947-6122
(219) 947-6045
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01042582
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000092005
ANTHEM PROVIDER NUMBER
IN
01
—
020037867
RR MCR PROVIDER #
IN
05
—
100473240B
—
IN
01
—
90001166
BC/BS OF ILLINOIS PROV #
IN
Enumeration date
06/15/2005
Last updated
04/25/2011
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