Healthcare Provider Details

I. General information

NPI: 1417342726
Provider Name (Legal Business Name): ARI MAXWELL STONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date: 05/19/2021
Reactivation Date: 06/22/2021

III. Provider practice location address

720 N BOND ST
SPRINGFIELD IL
62702-4952
US

IV. Provider business mailing address

PO BOX 19662
SPRINGFIELD IL
62794-9662
US

V. Phone/Fax

Practice location:
  • Phone: 608-622-5225
  • Fax:
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number125.077490
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: