Provider Demographics
NPI:1356360614
Name:RESCHAK, STEVEN CHRISTOPHER (DO)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CHRISTOPHER
Last Name:RESCHAK
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 1:3455 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51014325207Y00000X
MI5101014325207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4638591Medicaid
MII17991Medicare UPIN
MIN99760Medicare ID - Type Unspecified