Provider Demographics
NPI:1508992041
Name:MICHAEL E. STACHECKI, M.D., P.L.L.C.
Entity Type:Organization
Organization Name:MICHAEL E. STACHECKI, M.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER--MANAGING AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:STACHECKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-620-1720
Mailing Address - Street 1:5885 S MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2981
Mailing Address - Country:US
Mailing Address - Phone:248-620-1720
Mailing Address - Fax:248-620-1740
Practice Address - Street 1:5885 S MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2981
Practice Address - Country:US
Practice Address - Phone:248-620-1720
Practice Address - Fax:248-620-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058225207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P42580Medicare PIN