Provider Demographics
NPI:1750613717
Name:STASIOR, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:STASIOR
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 1:3148 N CLIFTON AVE
Mailing Address - Street 2:APT. 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3315
Mailing Address - Country:US
Mailing Address - Phone:773-525-3314
Mailing Address - Fax:
Practice Address - Street 1:3148 N CLIFTON AVE
Practice Address - Street 2:APT. 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3315
Practice Address - Country:US
Practice Address - Phone:773-525-3314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.055214207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine