STANA NICKOLICH MD
NPI 1104516004
Student in an Organized Health Care Education/Training Program in Canton, MI

Q: What is Stana Nickolich's NPI number?

The NPI number for Stana Nickolich is 1104516004. It was assigned to this individual provider in the NPPES registry on May 12, 2023.

Q: What is Stana Nickolich's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Stana Nickolich was last updated on May 12, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 12, 2023PECOS Enrolled

1051 N CANTON CENTER RD, CANTON, MI 48187(734) 647-5670 Get Directions Write a Review

NPPES record last updated: May 12, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Stana Nickolich Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STANA NICKOLICH MD (NPI 1104516004) is an individual student in an organized health care education/training program in Canton, Michigan, licensed in Michigan (4351050571) and active in the NPI registry since May 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104516004

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameSTANA NICKOLICHCredential: MD

Location Address1051 N CANTON CENTER RDCanton, MI 48187-5097

Mailing Address1500 E Medical Center Dr Spc 5368Ann Arbor, MI 48109-5368

Phone(734) 647-5670

Sole ProprietorNo

Enumeration DateMay 12, 2023

NPPES CertifiedMay 12, 2023

✔ NPI 1104516004 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

License✔ Licensed in MI · 4351050571

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1051 N CANTON CENTER RD, Canton, MI 48187

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Stana Nickolich Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GENEVIEVE ALLEN MD

Student in an Organized Health Care Education/Training Program