MEDICARE: MICHAEL D STANIEC M.D. P.C.

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
1	261QP2300X	Primary Care Clinic/Center	10600	AZ

General Provider Information

NPI Number	:	1386951374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL D STANIEC M.D. P.C.

Provider Business Mailing Address
First Line	:	5601 W EUGIE AVE STE 203
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-1258
Country	:	US
Telephone Number	:	602-548-1600
Fax Number	:	602-548-2470

Provider Business Practice Location Address
First Line	:	5601 W EUGIE AVE STE 203
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-1258
Country	:	US
Telephone Number	:	602-548-1600
Fax Number	:	602-548-2470

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL DOUGLAS STANIEC
Credential	:	M.D.
Telephone Number	:	602-548-1600

Provider Enumeration Date	:	09/12/2010
Last Update Date	:	09/12/2010

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