Healthcare Provider Details

I. General information

NPI: 1164462248
Provider Name (Legal Business Name): JOSEPH STOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W CHESTNUT ST
CHICAGO IL
60610-3288
US

IV. Provider business mailing address

2000 GREEN RD SUITE 300
ANN ARBOR MI
48105-1598
US

V. Phone/Fax

Practice location:
  • Phone: 312-379-0228
  • Fax:
Mailing address:
  • Phone: 734-995-3764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number036-106198
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: