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NPI Code Detail

MEDICARE: STACIE RENEE GREGORY M.D.

MEDICARE: STACIE RENEE GREGORY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology Physician036-142803IL
2207YP0228XPediatric Otolaryngology Physician036-142803IL

General Provider Information

NPI Number : 1336436435
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACIE RENEE GREGORY M.D.
Provider Business Mailing Address
First Line : PO BOX 19639
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62794-9639
Country : US
Telephone Number : 217-545-8000
Fax Number : 217-545-0253
Provider Business Practice Location Address
First Line : 720 N BOND ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62702-4952
Country : US
Telephone Number : 217-545-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2011
Last Update Date : 02/12/2026

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