Provider Demographics
NPI:1861724619
Name:MICHAEL P STANICH DO INC
Entity type:Organization
Organization Name:MICHAEL P STANICH DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:STANICH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-726-9077
Mailing Address - Street 1:7067 TIFFANY BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1981
Mailing Address - Country:US
Mailing Address - Phone:330-726-9077
Mailing Address - Fax:330-726-8715
Practice Address - Street 1:7067 TIFFANY BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1981
Practice Address - Country:US
Practice Address - Phone:330-726-9077
Practice Address - Fax:330-726-8715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003460207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0534652Medicare PIN