Provider Demographics
NPI:1265694335
Name:STALIN, VASANTH (MD)
Entity type:Individual
Prefix:DR
First Name:VASANTH
Middle Name:
Last Name:STALIN
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 1:1015 S WASHINGTON AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2556
Mailing Address - Country:US
Mailing Address - Phone:989-907-8716
Mailing Address - Fax:989-907-8207
Practice Address - Street 1:912 S WASHINGTON AVE
Practice Address - Street 2:STE. 1
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2564
Practice Address - Country:US
Practice Address - Phone:989-790-1001
Practice Address - Fax:989-790-1002
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28996208600000X
OH91503208600000X
MI4301097830208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery