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General NPI Number Information
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NPI Number | 1912128232
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Entity Type | Individual
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Provider Name | MICHAEL O STICK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 256 SW WASHINGTON AVE
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City | MADISON
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State | FL
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Zip | 32340-1982
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Country | US
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Telephone | 850-973-4590
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Fax |
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Provider Business Mailing Address
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Address Line | 2599 SW COUNTY ROAD 360A
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City | MADISON
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State | FL
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Zip | 32340-8416
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Country | US
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Telephone | 850-973-3613
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME38518
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License Number State | FL
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