Provider Demographics
NPI:1811934805
Name:TAO, STANLEY L (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:L
Last Name:TAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1180 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3190
Mailing Address - Country:US
Mailing Address - Phone:734-243-5300
Mailing Address - Fax:734-243-9956
Practice Address - Street 1:5085 MONROE ST
Practice Address - Street 2:STE. A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3455
Practice Address - Country:US
Practice Address - Phone:419-776-1004
Practice Address - Fax:419-776-1020
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY234064207W00000X
TNMD0000041297207W00000X
MI4301091260207W00000X
OH35090952207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1811934805Medicaid
OH9310793Medicare PIN
MI0N14190Medicare PIN
OH9310791Medicare PIN
OH4234472Medicare PIN
OH9310794Medicare PIN
OHP00630739Medicare PIN
MI1811934805Medicaid
MIP00635301Medicare PIN