Provider Demographics
NPI:1962552794
Name:DUDEK, STANLEY E (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:E
Last Name:DUDEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2121 ABBOTT RD
Mailing Address - Street 2:SUITE3
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8535
Mailing Address - Country:US
Mailing Address - Phone:517-351-6000
Mailing Address - Fax:517-351-0473
Practice Address - Street 1:2121 ABBOTT RD
Practice Address - Street 2:SUITE3
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8535
Practice Address - Country:US
Practice Address - Phone:517-351-6000
Practice Address - Fax:517-351-0473
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301039222207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1007002OtherMCLAUREN MEDICAID
MI4457854Medicaid
MI4414142OtherAETNA
MID91266Medicare UPIN
MI1007002OtherMCLAUREN MEDICAID