Provider Demographics
NPI:1164511200
Name:STASIK, CHAD NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:NICHOLAS
Last Name:STASIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 MEDICAL DR STE 325
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3389
Mailing Address - Country:US
Mailing Address - Phone:210-615-7700
Mailing Address - Fax:
Practice Address - Street 1:4330 MEDICAL DR STE 325
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3389
Practice Address - Country:US
Practice Address - Phone:210-615-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017007403208600000X, 208G00000X
FLTRN8846208600000X
TXN5416208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB151365Medicare PIN