Provider Demographics
NPI:1053842443
Name:STACK, KAROLINA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAROLINA
Middle Name:
Last Name:STACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAROLINA
Other - Middle Name:
Other - Last Name:SABALIAUSKAITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:525 E CONGRESS PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6258
Mailing Address - Country:US
Mailing Address - Phone:815-459-6780
Mailing Address - Fax:815-459-1648
Practice Address - Street 1:525 E CONGRESS PKWY STE 220
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6258
Practice Address - Country:US
Practice Address - Phone:815-459-6780
Practice Address - Fax:815-459-1648
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1053842243208000000X
IL036.151998208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty