Provider Demographics
NPI:1417917766
Name:STASZEL, MICHAEL ZBINIEW (DO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ZBINIEW
Last Name:STASZEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 N. BALLS FERRY RD.
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3537
Mailing Address - Country:US
Mailing Address - Phone:530-365-4412
Mailing Address - Fax:530-365-5186
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:530-365-4412
Practice Address - Fax:530-365-5186
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8493208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH07214Medicare UPIN