Individual
DR. MICHAEL THADDEUS STANEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 203-9600
Mailing address
4440 W 95TH ST, OAK LAWN, IL 60453-2600
(708) 684-5375
(708) 684-1028
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01080472A
IN
390200000X
Student in an Organized Health Care Education/Training Program
125.066376
IL
Other
Enumeration date
06/23/2015
Last updated
07/05/2018
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