Basic Information
| Provider Information | |||||||||
| NPI: | 1548317902 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STANLEY L ENGELHARDT, MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7192 TEN HL | ||||||||
| Address2: | |||||||||
| City: | W BLOOMFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483224239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3136002700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 42536 HAYES RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CLINTON TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480386766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862869644 | ||||||||
| FaxNumber: | 5862869647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ENGELHARDT | ||||||||
| AuthorizedOfficialFirstName: | STANLEY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5862869644 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 4301030406 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.