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Contact Information

PATRICK W STACK, MD
1373 E SR 62
MADISON, IN47250
 Phone: 812-801-0300
 Fax: 812-801-0585
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for PATRICK W STACK · (Male)

NPI Number 1710918891
Status Active
Credentials MD
Entity Individual
Enumeration date 07/06/2006
Last updated 02/20/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 01033161
  • IN Medicaid 100148850A
  • KY Medicaid 64759798
  • Other 4370916 AETNA
  • IN Other 000000042211 ANTHEM BCBS
  • IN Other 412626P SIHO
  • KY Other 2435578000 PASSPORT ADVANTAGE
  • KY Other 1082594 PASSPORT KY MEDICAID
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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