MEDICARE: STAMATIN INTERNAL MEDICINE PC

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	207R00000X	Internal Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DD4492	OTHER		MEDICARE RR

General Provider Information

NPI Number	:	1356426506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAMATIN INTERNAL MEDICINE PC

Provider Business Mailing Address
First Line	:	330 W TIENKEN RD
Second Line	:	SUITE C
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-4474
Country	:	US
Telephone Number	:	248-651-2620
Fax Number	:	248-651-9450

Provider Business Practice Location Address
First Line	:	330 W TIENKEN RD
Second Line	:	SUITE C
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-4474
Country	:	US
Telephone Number	:	248-651-2620
Fax Number	:	248-651-9450

Authorized Official
Title or Position	:	OWNER
Name	:	RICA STAMATIN
Credential	:	MD
Telephone Number	:	248-651-2620

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	09/24/2008

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Directions to “STAMATIN INTERNAL MEDICINE PC ” Practice Location

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