Healthcare Provider Details

I. General information

NPI: 1912995754
Provider Name (Legal Business Name): STUART FRANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 N RUTLEDGE ST 5TH FLOOR
SPRINGFIELD IL
62702-6700
US

IV. Provider business mailing address

747 N RUTLEDGE ST PO BOX 19627
SPRINGFIELD IL
62702-6700
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-7063
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-7063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036055701
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: