Provider Demographics
NPI:1790977494
Name:STANLEY S. ROLAND, D.O., P.C.
Entity Type:Organization
Organization Name:STANLEY S. ROLAND, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:SZUMIAK
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-667-9000
Mailing Address - Street 1:610 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446
Mailing Address - Country:US
Mailing Address - Phone:810-667-9000
Mailing Address - Fax:810-667-2001
Practice Address - Street 1:610 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446
Practice Address - Country:US
Practice Address - Phone:810-667-9000
Practice Address - Fax:810-667-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISR007473207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9440027Medicare PIN
E26765Medicare UPIN
5504884Medicare PIN