Individual
PATRICK W STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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