Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301095763 | MI |
N | 208600000X | Surgeon | 4301095763 | MI |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 4301095763 | MI |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 45389 | MN |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 53205 | AZ |
N | 208G00000X | Cardiothoracic Vascular Surgeon | ME130155 | FL |
NPI | 1154392587 |
---|---|
Provider Name | John M Stulak |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 20/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H76732 | (02) | |
H76732 | (02) | MI |