Provider Demographics
NPI:1962689786
Name:STEVEN C RESCHAK DO PC
Entity Type:Organization
Organization Name:STEVEN C RESCHAK DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RESCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-694-0600
Mailing Address - Street 1:3455 REGENCY PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2559
Mailing Address - Country:US
Mailing Address - Phone:810-694-0600
Mailing Address - Fax:810-694-0601
Practice Address - Street 1:3455 REGENCY PARK DR
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2559
Practice Address - Country:US
Practice Address - Phone:810-694-0600
Practice Address - Fax:810-694-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014325207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N99760Medicare PIN