Provider Demographics
NPI:1659490464
Name:STAPISH, RANDY C (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:C
Last Name:STAPISH
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:8623 N TELEGRAPH RD
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1489
Mailing Address - Country:US
Mailing Address - Phone:313-561-4540
Mailing Address - Fax:313-561-9515
Practice Address - Street 1:8623 N TELEGRAPH RD
Practice Address - Street 2:SUITE # 1
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1489
Practice Address - Country:US
Practice Address - Phone:313-561-4540
Practice Address - Fax:313-561-9515
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIRS001463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant