Healthcare Provider Details

I. General information

NPI: 1891858346
Provider Name (Legal Business Name): RONALD S STUMBRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18400 MAPLE CREEK DR STE 700
TINLEY PARK IL
60477-3027
US

IV. Provider business mailing address

PO BOX 296
PALOS HEIGHTS IL
60463-0296
US

V. Phone/Fax

Practice location:
  • Phone: 708-448-6720
  • Fax:
Mailing address:
  • Phone: 708-448-0870
  • Fax: 708-448-6720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number036-088148
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036-088148
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: