Provider Demographics
NPI:1215964689
Name:STANCIL, STANLEY H (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:H
Last Name:STANCIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N WABASH AVE STE 475
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2685
Mailing Address - Country:US
Mailing Address - Phone:765-661-3522
Mailing Address - Fax:
Practice Address - Street 1:2900 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3510
Practice Address - Country:US
Practice Address - Phone:812-275-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0158207L00000X
MI4301081102207L00000X, 2083A0100X
IN01060589A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01060589AOtherINDIANA
MI05-0-41-1646-1OtherBCBS PIN
MI4913042Medicaid
MI050D110480OtherBCBS GROUP PIN
MI081102SSOtherBCBS LICENSE
MI4301081102OtherSTATE LICENSE
MIM38730023OtherMEDICARE B
MIP00403528OtherRAILROAD MEDICARE
MI050D110480OtherBCBS GROUP PIN