Provider Demographics
NPI:1457320442
Name:STADNICK, MICHAEL EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EDWARD
Last Name:STADNICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:308 N PETERS ROAD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922
Mailing Address - Country:US
Mailing Address - Phone:865-694-0062
Mailing Address - Fax:865-694-7907
Practice Address - Street 1:8 CADILLAC DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-376-7500
Practice Address - Fax:615-376-7575
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-03-26
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Provider Licenses
StateLicense IDTaxonomies
IN01058110A2085R0202X
NJMA766472085R0202X
LA15219R2085R0202X
AL000257642085R0202X
MT104952085R0202X
KY384172085R0202X
NY1808062085R0202X
FLME842192085R0202X
GA0515552085R0202X
TN305982085R0202X
NMT200204592085R0202X
OH822672085R0202X
AZ314782085R0202X
CO419332085R0202X
IL0361101262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3825066Medicaid
TN3825066Medicare PIN
TN3825066Medicaid