Provider Demographics
NPI:1750342168
Name:STADIEM, MICHAEL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:STADIEM
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 1:1151 SE CARY PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7418
Mailing Address - Country:US
Mailing Address - Phone:919-851-3292
Mailing Address - Fax:919-851-3434
Practice Address - Street 1:1151 SE CARY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7418
Practice Address - Country:US
Practice Address - Phone:919-851-3292
Practice Address - Fax:919-851-3434
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790128CMedicaid
NCD92644Medicare UPIN
NC202218DMedicare PIN