Provider Demographics
NPI:1649572041
Name:GOLEC, STANISLAW (MD)
Entity Type:Individual
Prefix:DR
First Name:STANISLAW
Middle Name:
Last Name:GOLEC
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 1:32418 OLDE FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1740
Mailing Address - Country:US
Mailing Address - Phone:248-855-5970
Mailing Address - Fax:
Practice Address - Street 1:32418 OLDE FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1740
Practice Address - Country:US
Practice Address - Phone:248-855-5970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010486942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4155129Medicaid
MI0829199OtherBCBSM