Provider Demographics
NPI:1356455463
Name:STADNYK, MICHAEL J (M D)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:STADNYK
Suffix:
Gender:M
Credentials:M D
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2153 DEPT 30755
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-9283
Mailing Address - Country:US
Mailing Address - Phone:314-238-5260
Mailing Address - Fax:314-821-1833
Practice Address - Street 1:36 CHESTERFIELD LAKE ROAD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-4505
Practice Address - Country:US
Practice Address - Phone:573-334-6071
Practice Address - Fax:573-334-4739
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1033462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G32279OtherMERCY HEALTH PLAN
P00295078OtherRAILROAD MEDICARE
27716OtherGROUP HEALTH PLAN
194361OtherBLUE SHIELD
MO208094714Medicaid
58770V12822OtherHEALTHCARE USA
3848OtherCMR
332305OtherHEALTHLINK