Individual
PATRICK W STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1373 E SR 62, MADISON, IN 47250
(812) 801-0300
(812) 801-0585
Mailing address
PO BOX 3395, EVANSVILLE, IN 47732-3395
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01033161
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042211
ANTHEM BCBS
IN
05
—
100148850A
—
IN
01
—
1082594
PASSPORT KY MEDICAID
KY
01
—
2435578000
PASSPORT ADVANTAGE
KY
01
—
412626P
SIHO
IN
01
—
4370916
AETNA
—
05
—
64759798
—
KY
Enumeration date
07/06/2006
Last updated
02/20/2019
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