Healthcare Provider Details

I. General information

NPI: 1992144174
Provider Name (Legal Business Name): KARL WILLIAM STASER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BELLEMEADE AVE STE 120
EVANSVILLE IN
47714-0111
US

IV. Provider business mailing address

3801 BELLEMEADE AVE STE 120
EVANSVILLE IN
47714-0111
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2017010789
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01081738A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: