MEDICARE: DR. VASANTH STALIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD28996	OR
2	208600000X	Surgery Physician	91503	OH
3	208600000X	Surgery Physician	4301097830	MI

General Provider Information

NPI Number	:	1265694335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VASANTH STALIN M.D.

Provider Business Mailing Address
First Line	:	1015 S WASHINGTON AVE FL 3
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48601-2556
Country	:	US
Telephone Number	:	989-907-8716
Fax Number	:	989-907-8207

Provider Business Practice Location Address
First Line	:	912 S WASHINGTON AVE
Second Line	:	STE. 1
City	:	SAGINAW
State	:	MI
Zip	:	48601-2564
Country	:	US
Telephone Number	:	989-790-1001
Fax Number	:	989-790-1002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	07/24/2019

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