Provider Demographics
NPI:1396209086
Name:MICHAEL STASZEL D.O. P.A
Entity Type:Organization
Organization Name:MICHAEL STASZEL D.O. P.A
Other - Org Name:OFFICE OF MICHAEL STASZEL, D.O P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:Z
Authorized Official - Last Name:STASZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:530-926-5261
Mailing Address - Street 1:822 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-2137
Mailing Address - Country:US
Mailing Address - Phone:530-926-5261
Mailing Address - Fax:
Practice Address - Street 1:822 PINE ST
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2137
Practice Address - Country:US
Practice Address - Phone:530-926-5261
Practice Address - Fax:530-926-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-26
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care