Provider Demographics
NPI:1902837800
Name:STIFF, MICHAEL G (MD, INC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:STIFF
Suffix:
Gender:M
Credentials:MD, INC
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 374
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-0374
Mailing Address - Country:US
Mailing Address - Phone:614-879-0434
Mailing Address - Fax:614-879-0435
Practice Address - Street 1:495 COOPER RD
Practice Address - Street 2:#330
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8780
Practice Address - Country:US
Practice Address - Phone:614-898-8576
Practice Address - Fax:614-898-8577
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048596174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0672204Medicaid
OH0672204Medicaid
OHA16530Medicare UPIN