Provider Demographics
NPI:1063569879
Name:POZNANSKI, STACEY LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LYNN
Last Name:POZNANSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:BRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:9387 PARAGON MILLS LN
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-4185
Mailing Address - Country:US
Mailing Address - Phone:608-770-6005
Mailing Address - Fax:
Practice Address - Street 1:3525 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1221
Practice Address - Country:US
Practice Address - Phone:937-395-8839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51684207P00000X
390200000X
OH009855207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3069003Medicaid
OH4301781OtherMEDICARE PTAN
OH4301782OtherMEDICARE PTAN