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General NPI Number Information
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NPI Number | 1861724619
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Entity Type | Organization
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Legal Business Name | MICHAEL P STANICH DO INC
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Dates
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Enumeration Date | 02/04/2010
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 7067 TIFFANY BLVD SUITE 150
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City | YOUNGSTOWN
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State | OH
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Zip | 44514-1981
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Country | US
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Telephone | 330-726-9077
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Fax | 330-726-8715
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Provider Business Mailing Address
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Address Line | 7067 TIFFANY BLVD SUITE 150
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City | YOUNGSTOWN
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State | OH
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Zip | 44514-1981
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Country | US
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Telephone | 330-726-9077
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Fax | 330-726-8715
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL P STANICH
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Credential | DO
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Telephone | 330-726-9077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 34003460
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License Number State | OH
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