Healthcare Provider Details

I. General information

NPI: 1942452925
Provider Name (Legal Business Name): VAIDA M. STOIK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 HOSPITAL DR SUITE 200
SANTA FE NM
87505-4769
US

IV. Provider business mailing address

1650 HOSPITAL DR SUITE 200
SANTA FE NM
87505-4769
US

V. Phone/Fax

Practice location:
  • Phone: 505-216-3745
  • Fax: 505-982-5003
Mailing address:
  • Phone: 505-216-3745
  • Fax: 505-982-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD2008-0204
License Number StateNM

VIII. Authorized Official

Name: DR. VAIDA MACIUTE STOIK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 937-477-4872