Healthcare Provider Details

I. General information

NPI: 1245714260
Provider Name (Legal Business Name): MAKSIM STADNIK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0002
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0002
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone: 216-444-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019742
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: