Healthcare Provider Details

I. General information

NPI: 1447295282
Provider Name (Legal Business Name): ALEXANDER L STONOV M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E BRUSH HILL RD
ELMHURST IL
60126-5658
US

IV. Provider business mailing address

255 W MICHIGAN AVE
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-1000
  • Fax:
Mailing address:
  • Phone: 517-787-6440
  • Fax: 517-787-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036105878
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: