Provider Demographics
NPI:1023105996
Name:BIENASZ, STANLEY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:MICHAEL
Last Name:BIENASZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 LAKE DESIARD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2036
Mailing Address - Country:US
Mailing Address - Phone:318-398-0434
Mailing Address - Fax:318-398-0902
Practice Address - Street 1:503 MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5327
Practice Address - Country:US
Practice Address - Phone:318-329-4313
Practice Address - Fax:318-329-4316
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018339207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1375519Medicaid
LA5J579Medicare PIN
LAE48714Medicare UPIN
LA1375519Medicaid