Provider Demographics
NPI:1851322465
Name:SANDICK, STANLEY M (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:M
Last Name:SANDICK
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:PO BOX 2417
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-2417
Mailing Address - Country:US
Mailing Address - Phone:307-638-0300
Mailing Address - Fax:307-638-0394
Practice Address - Street 1:214 E 23RD ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3748
Practice Address - Country:US
Practice Address - Phone:307-638-0300
Practice Address - Fax:307-638-0394
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3464A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY308213OtherBLUE CROSS BLUE SHIELD
WYW308212Medicare ID - Type Unspecified
WYA73015Medicare UPIN