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NPI Code Detail

MEDICARE: CYNTHIA STATLER M.D.

MEDICARE: CYNTHIA STATLER 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
1208000000XPediatrics Physician4301060609MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649291048
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYNTHIA STATLER M.D.
Provider Business Mailing Address
First Line : 14734 PARK AVE
Second Line :
City : CHARLEVOIX
State : MI
Zip : 49720-1927
Country : US
Telephone Number : 231-547-6554
Fax Number : 231-547-1179
Provider Business Practice Location Address
First Line : 14734 PARK AVE
Second Line :
City : CHARLEVOIX
State : MI
Zip : 49720-1927
Country : US
Telephone Number : 231-547-6554
Fax Number : 231-547-1179
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 07/02/2014

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Directions to “ CYNTHIA STATLER M.D.” Practice Location

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