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General NPI Number Information
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NPI Number | 1750313094
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Entity Type | Individual
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Provider Name | MATTHEW W STADNYK MD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 12303 DEPAUL DR DEPAUL HEALTH CENTER
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City | BRIDGETON
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State | MO
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Zip | 63044
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Country | US
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Telephone | 314-344-6350
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2153 DEPT 30755
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City | BIRMINGHAM
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State | AL
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Zip | 35287-9283
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Country | US
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Telephone | 314-238-5260
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Fax | 314-821-1833
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35577
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036105557
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 105955
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License Number State | MO
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