MEDICARE: DR. KARL WILLIAM STASER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	2017010789	MO
2	207N00000X	Dermatology Physician	01081738A	IN

General Provider Information

NPI Number	:	1992144174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARL WILLIAM STASER MD

Provider Business Mailing Address
First Line	:	3801 BELLEMEADE AVE STE 120
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-0111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 BELLEMEADE AVE STE 120
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-0111
Country	:	US
Telephone Number	:	812-485-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	09/01/2022

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