Provider Demographics
NPI:1699862490
Name:STACHOWICZ, PAWEL P (MD)
Entity type:Individual
Prefix:
First Name:PAWEL
Middle Name:P
Last Name:STACHOWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PLYMOUTH RD
Mailing Address - Street 2:SUITE #260
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2366
Mailing Address - Country:US
Mailing Address - Phone:612-360-6466
Mailing Address - Fax:
Practice Address - Street 1:3005 KNOX AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2542
Practice Address - Country:US
Practice Address - Phone:612-770-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39698208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3843254000Medicaid
MN020001787Medicare ID - Type Unspecified
MNG83066Medicare UPIN