Healthcare Provider Details

I. General information

NPI: 1851745251
Provider Name (Legal Business Name): KATHERINE STACHOWICZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 LINCOLN AVE
BEDFORD IN
47421-2142
US

IV. Provider business mailing address

515 SOUTHRIDGE DR
BEDFORD IN
47421-9262
US

V. Phone/Fax

Practice location:
  • Phone: 812-675-4470
  • Fax: 812-675-4469
Mailing address:
  • Phone: 812-723-3944
  • Fax: 812-723-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02008813A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: