Healthcare Provider Details

I. General information

NPI: 1346297900
Provider Name (Legal Business Name): THOMAS G STAYSNIAK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 HUMMINGBIRD RD STE 100
WAUSAU WI
54401-6312
US

IV. Provider business mailing address

5200 HUMMINGBIRD RD STE 100
WAUSAU WI
54401-6312
US

V. Phone/Fax

Practice location:
  • Phone: 715-359-6442
  • Fax: 715-393-0390
Mailing address:
  • Phone: 715-359-6442
  • Fax: 715-393-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number695
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number695
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: