Provider Demographics
NPI:1245292192
Name:STEHLIK, EDWARD A SR (MD, FACP)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:STEHLIK
Suffix:SR
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1783 COLVIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1107
Mailing Address - Country:US
Mailing Address - Phone:716-874-2150
Mailing Address - Fax:716-874-6765
Practice Address - Street 1:1783 COLVIN BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1107
Practice Address - Country:US
Practice Address - Phone:716-874-2150
Practice Address - Fax:716-874-6765
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY647470Medicaid
NY647470Medicaid
NYB71654Medicare UPIN