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General NPI Number Information
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NPI Number | 1164511200
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Entity Type | Individual
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Provider Name | CHAD NICHOLAS STASIK M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 4330 MEDICAL DR STE 325
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3389
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Country | US
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Telephone | 210-615-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 4330 MEDICAL DR STE 325
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3389
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Country | US
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Telephone | 210-615-7700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2017007403
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | TRN8846
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 2017007403
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | N5416
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License Number State | TX
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