Provider Demographics
NPI:1881041374
Name:STENCEL, MICHAEL G (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:STENCEL
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 1:1220 LEE ST E STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1864
Mailing Address - Country:US
Mailing Address - Phone:304-388-1965
Mailing Address - Fax:304-388-1969
Practice Address - Street 1:1220 LEE ST E STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1864
Practice Address - Country:US
Practice Address - Phone:304-388-1965
Practice Address - Fax:304-388-1969
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS021419208800000X
390200000X
WV4112208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program