Healthcare Provider Details

I. General information

NPI: 1962083303
Provider Name (Legal Business Name): AMY STASIK MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-955-6450
  • Fax: 414-955-0082
Mailing address:
  • Phone: 414-955-6450
  • Fax: 414-955-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number85653
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: