Provider Demographics
NPI:1386951374
Name:MICHAEL D STANIEC M.D. P.C.
Entity type:Organization
Organization Name:MICHAEL D STANIEC M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:STANIEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-548-1600
Mailing Address - Street 1:5601 W EUGIE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1258
Mailing Address - Country:US
Mailing Address - Phone:602-548-1600
Mailing Address - Fax:602-548-2470
Practice Address - Street 1:5601 W EUGIE AVE STE 203
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1258
Practice Address - Country:US
Practice Address - Phone:602-548-1600
Practice Address - Fax:602-548-2470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-12
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10600261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZMD10600Medicare PIN
AZD37691Medicare UPIN