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General NPI Number Information
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NPI Number | 1508992041
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Entity Type | Organization
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Legal Business Name | MICHAEL E. STACHECKI, M.D., P.L.L.C.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 5885 S MAIN ST SUITE 3
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City | CLARKSTON
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State | MI
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Zip | 48346-2981
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Country | US
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Telephone | 248-620-1720
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Fax | 248-620-1740
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Provider Business Mailing Address
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Address Line | 5885 S MAIN ST SUITE 3
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City | CLARKSTON
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State | MI
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Zip | 48346-2981
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Country | US
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Telephone | 248-620-1720
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Fax | 248-620-1740
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Authorized Official
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Title or Position | OWNER--MANAGING AGENT
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Name | DR. MICHAEL E STACHECKI
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Credential | M.D.
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Telephone | 248-620-1720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301058225
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301058225
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License Number State | MI
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