Provider Demographics
NPI:1982891180
Name:STEPHEN B REZNICEK M.D. P.C.
Entity type:Organization
Organization Name:STEPHEN B REZNICEK M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:REZNICEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-779-2565
Mailing Address - Street 1:1011 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8735
Mailing Address - Country:US
Mailing Address - Phone:231-779-2565
Mailing Address - Fax:231-775-0744
Practice Address - Street 1:1011 SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8735
Practice Address - Country:US
Practice Address - Phone:231-779-2565
Practice Address - Fax:231-775-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3408300152OtherBLUE CROSS
MI0P50120Medicare PIN
MI3408300152OtherBLUE CROSS
MI0830015Medicare UPIN
MIA02517Medicare UPIN