Provider Demographics
NPI:1497715072
Name:STOLER, RICHARD K (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:K
Last Name:STOLER
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 1:14555 LEVAN RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5083
Mailing Address - Country:US
Mailing Address - Phone:734-462-3222
Mailing Address - Fax:734-462-3227
Practice Address - Street 1:14555 LEVAN RD
Practice Address - Street 2:SUITE 206
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5083
Practice Address - Country:US
Practice Address - Phone:734-462-3222
Practice Address - Fax:734-462-3227
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRS006448207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0458216354OtherBLUE CROSS BLUE SHIELD MI
MIP49960002Medicare PIN
MI0458216354OtherBLUE CROSS BLUE SHIELD MI