MEDICARE: MICHAEL DOUGLAS STANIEC M.D.

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	207Q00000X	Family Medicine Physician	10600	AZ

General Provider Information

NPI Number	:	1497771471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DOUGLAS STANIEC M.D.

Provider Business Mailing Address
First Line	:	42429 N CROSS TIMBERS CT
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-1098
Country	:	US
Telephone Number	:	623-551-1097
Fax Number	:	602-548-2470

Provider Business Practice Location Address
First Line	:	5601 W EUGIE AVE
Second Line	:	SUITE 203
City	:	GLENDALE
State	:	AZ
Zip	:	85304-1255
Country	:	US
Telephone Number	:	602-548-1600
Fax Number	:	602-548-2470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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