MEDICARE: DANIEL STACHELSKI 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	207Q00000X	Family Medicine Physician	4301054741	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992797898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL STACHELSKI M.D.

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22646 E 9 MILE RD
Second Line	:	SUITE A
City	:	ST CLAIR SHORES
State	:	MI
Zip	:	48080-1951
Country	:	US
Telephone Number	:	586-498-4800
Fax Number	:	586-498-4830

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	10/23/2020

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