Provider Demographics
NPI:1013988278
Name:ROLAND, STANLEY SZUMIAK (DO)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:SZUMIAK
Last Name:ROLAND
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 1:610 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446
Mailing Address - Country:US
Mailing Address - Phone:810-667-9000
Mailing Address - Fax:810-667-2001
Practice Address - Street 1:610 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446
Practice Address - Country:US
Practice Address - Phone:810-667-9000
Practice Address - Fax:810-667-2001
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISR007473207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0754400304OtherBLUE CROSS BLUE SHIELD
5504884Medicare ID - Type UnspecifiedROMEO
MI0754400304OtherBLUE CROSS BLUE SHIELD
E26765Medicare UPIN