Provider Demographics
NPI:1316942923
Name:STADNIK, JOHN CLIFTON (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CLIFTON
Last Name:STADNIK
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 1:4440 RED BANK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2176
Mailing Address - Country:US
Mailing Address - Phone:513-564-1366
Mailing Address - Fax:513-564-1367
Practice Address - Street 1:4440 RED BANK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2176
Practice Address - Country:US
Practice Address - Phone:513-564-1366
Practice Address - Fax:513-564-1367
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068198207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200462130Medicaid
KY64085319Medicaid
OH0167895Medicaid
OH0167895Medicaid