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NPI Code Detail

MEDICARE: STAMATIN INTERNAL MEDICINE PC

MEDICARE: STAMATIN INTERNAL MEDICINE PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DD4492OTHERMEDICARE RR

General Provider Information

NPI Number : 1356426506
Entity Type Code : Organization
Provider Name (Legal Business Name) : STAMATIN INTERNAL MEDICINE PC
Provider Business Mailing Address
First Line : 330 W TIENKEN RD
Second Line : SUITE C
City : ROCHESTER HILLS
State : MI
Zip : 48306-4474
Country : US
Telephone Number : 248-651-2620
Fax Number : 248-651-9450
Provider Business Practice Location Address
First Line : 330 W TIENKEN RD
Second Line : SUITE C
City : ROCHESTER HILLS
State : MI
Zip : 48306-4474
Country : US
Telephone Number : 248-651-2620
Fax Number : 248-651-9450
Authorized Official
Title or Position : OWNER
Name : RICA STAMATIN
Credential : MD
Telephone Number : 248-651-2620
Provider Enumeration Date : 10/26/2006
Last Update Date : 09/24/2008

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Directions to “STAMATIN INTERNAL MEDICINE PC ” Practice Location

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