Healthcare Provider Details

I. General information

NPI: 1023105996
Provider Name (Legal Business Name): STANLEY MICHAEL BIENASZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MCMILLAN RD
WEST MONROE LA
71291-5327
US

IV. Provider business mailing address

3302 LAKE DESIARD DR
MONROE LA
71201-2036
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-4313
  • Fax: 318-329-4316
Mailing address:
  • Phone: 318-398-0434
  • Fax: 318-398-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number018339
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: