Provider Demographics
NPI:1669449021
Name:STANLEY, MICHAEL G (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:STANLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 480
Mailing Address - Street 2:BOX 2559
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09128
Mailing Address - Country:DE
Mailing Address - Phone:49711-680-8385
Mailing Address - Fax:
Practice Address - Street 1:CMR 480
Practice Address - Street 2:BOX 2559
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09128
Practice Address - Country:DE
Practice Address - Phone:49711-680-8385
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine