Healthcare Provider Details

I. General information

NPI: 1104896521
Provider Name (Legal Business Name): MICHAEL CHARLES STUMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 COLLEGE ST
FINDLAY OH
45840-3618
US

IV. Provider business mailing address

340 COLLEGE ST
FINDLAY OH
45840-3618
US

V. Phone/Fax

Practice location:
  • Phone: 419-425-3199
  • Fax: 419-425-3012
Mailing address:
  • Phone: 419-425-3199
  • Fax: 419-425-3012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35063285
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: