Provider Demographics
NPI:1699193847
Name:ROUSE, STASIA (MD)
Entity Type:Individual
Prefix:DR
First Name:STASIA
Middle Name:
Last Name:ROUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STASIA
Other - Middle Name:DIANA
Other - Last Name:BEDNAREK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:1875 DEMPSTER ST STE 625
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1137
Practice Address - Country:US
Practice Address - Phone:847-723-7024
Practice Address - Fax:847-723-7369
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361464662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology