Provider Demographics
NPI:1427214816
Name:EUFEMI, STACI M (PA)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:M
Last Name:EUFEMI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:M
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:10767 ILLINOIS ST STE 3000
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8972
Mailing Address - Country:US
Mailing Address - Phone:317-817-1200
Mailing Address - Fax:317-817-1220
Practice Address - Street 1:10767 ILLINOIS ST STE 3000
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8972
Practice Address - Country:US
Practice Address - Phone:317-817-1200
Practice Address - Fax:317-817-1220
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001006A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
M400054626Medicare PIN
IN223110DDDDMedicare PIN