Provider Demographics
NPI:1639124647
Name:ZIOMEK, STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:ZIOMEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5043
Mailing Address - Country:US
Mailing Address - Phone:573-472-7120
Mailing Address - Fax:573-472-7129
Practice Address - Street 1:1015 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5043
Practice Address - Country:US
Practice Address - Phone:573-472-7120
Practice Address - Fax:573-472-7129
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005014706208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS203899208Medicaid
MO932134475Medicare ID - Type UnspecifiedMISSOURI MEDICARE
MS203899208Medicaid