Healthcare Provider Details

I. General information

NPI: 1174902472
Provider Name (Legal Business Name): VALERIE RYGIEL STANFORD D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W 95TH ST STE 100
OAK LAWN IL
60453-3072
US

IV. Provider business mailing address

10719 160TH ST
ORLAND PARK IL
60467-5541
US

V. Phone/Fax

Practice location:
  • Phone: 708-226-3300
  • Fax:
Mailing address:
  • Phone: 708-226-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125066448
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036.145406
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: