Healthcare Provider Details

I. General information

NPI: 1598943888
Provider Name (Legal Business Name): STONE MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 W. GRAND AVE
GURNEE IL
60031
US

IV. Provider business mailing address

7505 W. GRAND AVE
GURNEE IL
60031
US

V. Phone/Fax

Practice location:
  • Phone: 847-856-7615
  • Fax:
Mailing address:
  • Phone: 847-856-7615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number02410125
License Number StateIL

VIII. Authorized Official

Name: MRS. RAJESH SHARMA
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 847-856-7615