Provider Demographics
NPI:1144424664
Name:STADTMAUER, MICHAEL (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:STADTMAUER
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 IDX DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7773
Mailing Address - Country:US
Mailing Address - Phone:802-448-3388
Mailing Address - Fax:802-448-3387
Practice Address - Street 1:41 IDX DR
Practice Address - Street 2:SUITE 220
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7773
Practice Address - Country:US
Practice Address - Phone:802-448-3388
Practice Address - Fax:802-448-3387
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0047116175F00000X
VT0050447171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist