J. John Stasikowski, MD PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

E5623 Issued in TX

Legal business name

J. JOHN STASIKOWSKI, MD PA

Practice address

1307 8TH Ave
Suite 202
Fort Worth, TX 76104-4137

Phone

(817) 926-8002

Fax

(817) 926-2315

NPI assigned

Dec 29, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jacek John Stasikowski, M.D, P.A.

Title

Medical Doctor

Phone

(817) 926-8002

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325116800000",
    "number": "1093084568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 8TH AVE",
            "address_2": "SUITE 202",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044137",
            "telephone_number": "817-926-8002",
            "fax_number": "817-926-2315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 8TH AVE",
            "address_2": "SUITE 202",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044137",
            "telephone_number": "817-926-8002",
            "fax_number": "817-926-2315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J. JOHN STASIKOWSKI, MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-29",
        "last_updated": "2011-12-29",
        "status": "A",
        "authorized_official_last_name": "STASIKOWSKI",
        "authorized_official_first_name": "JACEK",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "817-926-8002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D, P.A."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TX",
            "license": "E5623",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1619921392",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031810701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Specialist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.