Healthcare Provider Details

I. General information

NPI: 1205005717
Provider Name (Legal Business Name): GURNEE STONE MEDICAL CENTER P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 GRAND AVE
GURNEE IL
60031-1551
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 Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAJESH SHARMA
Title or Position: MANAGER
Credential: M.D
Phone: 847-856-7615