Provider Demographics
NPI:1821009614
Name:STADER, ERIC E (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:E
Last Name:STADER
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 1:105 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-2019
Mailing Address - Country:US
Mailing Address - Phone:608-723-3100
Mailing Address - Fax:866-560-8783
Practice Address - Street 1:105 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-2019
Practice Address - Country:US
Practice Address - Phone:608-723-3100
Practice Address - Fax:866-560-8783
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34365100Medicaid
WIH38396Medicare UPIN
WI34365100Medicaid