Healthcare Provider Details

I. General information

NPI: 1578537809
Provider Name (Legal Business Name): RODNEY STUCK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE (17W740 22ND STREET, OAKBROOK TERRACE, IL. 60181)
MAYWOOD IL
60153
US

IV. Provider business mailing address

2160 S 1ST AVE (17W740 22ND STREET, OAKBROOK TERRACE, IL. 60181)
MAYWOOD IL
60153
US

V. Phone/Fax

Practice location:
  • Phone: 630-627-7399
  • Fax: 630-627-7079
Mailing address:
  • Phone: 630-627-7399
  • Fax: 630-627-7079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number16003859
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: