Healthcare Provider Details

I. General information

NPI: 1063459550
Provider Name (Legal Business Name): CURT STANKOVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDRENS HOSPITAL MI EMERGENCY MED 3901 BEAUBIEN ER DEPT - MAIN BUILDING
DETROIT MI
48201
US

IV. Provider business mailing address

4201 ST. ANTOINE UHC 5D UNIVERSITY PEDIATRICIANS
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5260
  • Fax: 313-993-7166
Mailing address:
  • Phone: 313-966-5051
  • Fax: 313-966-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301083615
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number4301083615
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: