Provider Demographics
NPI:1073625596
Name:STADIUS, MICHAEL LAURI (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LAURI
Last Name:STADIUS
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:VA MEDICAL CENTER-CARDIOLOGY (S-11
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-764-2008
Mailing Address - Fax:206-764-2257
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:VA MEDICAL CENTER-CARDIOLOGY (S-111-CARDIO)
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-764-2008
Practice Address - Fax:206-764-2257
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA19979207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A05694Medicare UPIN