Healthcare Provider Details

I. General information

NPI: 1659547172
Provider Name (Legal Business Name): GURNEE STONE MEDICAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 07/21/2022
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 GRAND AVE
GURNEE IL
60031-1551
US

V. Phone/Fax

Practice location:
  • Phone: 847-856-7615
  • Fax: 847-245-7070
Mailing address:
  • Phone: 847-856-7615
  • Fax: 847-245-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateIL

VIII. Authorized Official

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