Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01037409 | IN |
Y | 208600000X | Surgeon | 01037409 | IN |
N | 2082S0105X | Plastic Hand Surgeon | 01037409 | IN |
NPI | 1457448128 |
---|---|
Provider Name | Michael Cary Stalnecker |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Indianapolis, IN 46256-5630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 10/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000736570 | ANTHEM (01) | IN |
100128900 | (05) | IN |
A62937 | (02) | IN |
P01125741 | RAILROAD MEDICARE (01) | IN |