Provider Demographics
NPI:1790842706
Name:STASKUS, GITANA (MD)
Entity Type:Individual
Prefix:DR
First Name:GITANA
Middle Name:
Last Name:STASKUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 ARAPEEN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1267
Mailing Address - Country:US
Mailing Address - Phone:801-581-7761
Mailing Address - Fax:
Practice Address - Street 1:615 ARAPEEN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1267
Practice Address - Country:US
Practice Address - Phone:801-581-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-109743207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109743 1Medicaid
IL036109743 1Medicaid
IL214660 K25041Medicare ID - Type Unspecified