Provider Demographics
NPI:1306644901
Name:STACHOWIAK, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:STACHOWIAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 ARMADA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53911-9513
Mailing Address - Country:US
Mailing Address - Phone:920-712-9757
Mailing Address - Fax:
Practice Address - Street 1:321 ARMADA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53911-9513
Practice Address - Country:US
Practice Address - Phone:920-712-9757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)