Individual
MARA STASIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2900 W OKLAHOMA AVE, 5TH FLOOR GALLERIA, MILWAUKEE, WI 53215-4330
(414) 646-2550
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3369
WI
363AM0700X
Medical Physician Assistant
3369-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100041660
—
WI
Enumeration date
10/22/2014
Last updated
12/08/2023
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