Provider Demographics
NPI:1659345056
Name:STACHECKI, MICHAEL E (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:STACHECKI
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 1:5885 S MAIN ST STE 3
Mailing Address - Street 2:
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 STE 3
Practice Address - Street 2:
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
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058225208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106360120OtherBCBS
MI3162002Medicaid
MI1106360120OtherBCBS
MI0P42580Medicare PIN