Provider Demographics
NPI:1922196773
Name:STASZEL, JOHN W (DO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:STASZEL
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 1:46572 ROCKFORD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5630
Mailing Address - Country:US
Mailing Address - Phone:954-699-1025
Mailing Address - Fax:
Practice Address - Street 1:33089 GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-1501
Practice Address - Country:US
Practice Address - Phone:586-296-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME709502085R0202X
MI5101020606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology