Provider Demographics
NPI:1538186556
Name:CHARLES J. LOSTAK, D.O., P.A.
Entity type:Organization
Organization Name:CHARLES J. LOSTAK, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LOSTAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-948-8856
Mailing Address - Street 1:221 W COLORADO BLVD
Mailing Address - Street 2:PAVILION II, SUITE 940
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2363
Mailing Address - Country:US
Mailing Address - Phone:214-948-8856
Mailing Address - Fax:214-948-5516
Practice Address - Street 1:221 W COLORADO BLVD
Practice Address - Street 2:PAVILION II, SUITE 940
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2363
Practice Address - Country:US
Practice Address - Phone:214-948-8856
Practice Address - Fax:214-948-5516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0576207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1477549913OtherNPI INDIV. PROVIDER
TX8C2330Medicare ID - Type Unspecified
TXA67347Medicare UPIN
TX00273XMedicare ID - Type UnspecifiedMEDICARE GROUP