Provider Demographics
NPI:1023110996
Name:STAWSKI, PHILLIP A (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:A
Last Name:STAWSKI
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 1:601 W LEOTA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6525
Mailing Address - Country:US
Mailing Address - Phone:308-696-8000
Mailing Address - Fax:308-696-8349
Practice Address - Street 1:601 W LEOTA ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6525
Practice Address - Country:US
Practice Address - Phone:308-696-8000
Practice Address - Fax:308-696-8349
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.088278207P00000X
MI4301096161207P00000X
NE28091207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025588700Medicaid