Healthcare Provider Details

I. General information

NPI: 1730534322
Provider Name (Legal Business Name): JASON STOKLOSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W NORTH AVE
MELROSE PARK IL
60160-1612
US

IV. Provider business mailing address

701 W NORTH AVE
MELROSE PARK IL
60160-1612
US

V. Phone/Fax

Practice location:
  • Phone: 708-538-4934
  • Fax:
Mailing address:
  • Phone: 718-780-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036161161
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number305508
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: