Provider Demographics
NPI:1376526053
Name:ARCHACKI, STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:ARCHACKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34500 CHARDON ROAD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44094-3305
Mailing Address - Country:US
Mailing Address - Phone:440-386-4200
Mailing Address - Fax:440-943-4184
Practice Address - Street 1:34500 CHARDON ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44094-3305
Practice Address - Country:US
Practice Address - Phone:440-386-4200
Practice Address - Fax:440-943-4184
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-069237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2020753Medicaid
OH000000190386OtherANTHEM
OH000000190386OtherANTHEM
OH7296671Medicare ID - Type Unspecified