Provider Demographics
NPI:1053389775
Name:STACHERSKI, MARK D (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:STACHERSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:33523 8 MILE RD
Mailing Address - Street 2:STE M2
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4119
Mailing Address - Country:US
Mailing Address - Phone:734-432-7581
Mailing Address - Fax:734-853-5698
Practice Address - Street 1:37595 7 MILE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1003
Practice Address - Country:US
Practice Address - Phone:734-432-7581
Practice Address - Fax:734-853-5698
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2020-01-15
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Provider Licenses
StateLicense IDTaxonomies
MI4301060110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4619157Medicaid
N91620019Medicare ID - Type Unspecified
MI4619157Medicaid