Provider Demographics
NPI:1669489449
Name:STANO, GARY L (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:STANO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:24445 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-6501
Mailing Address - Country:US
Mailing Address - Phone:248-799-0086
Mailing Address - Fax:248-350-1178
Practice Address - Street 1:24445 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6501
Practice Address - Country:US
Practice Address - Phone:248-799-0086
Practice Address - Fax:248-350-1178
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001470213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5184125Medicaid
MI4856315900OtherBLUE CROSS BLUE SHIELD
MI4856315900OtherBLUE CROSS BLUE SHIELD
MI5184125Medicaid