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General NPI Number Information
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NPI Number | 1134622053
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Entity Type | Organization
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Legal Business Name | MAINSTAY CLINICS INC
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 333 PETERSON RD STE 240
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-1085
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Country | US
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Telephone | 224-864-2124
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Fax | 224-864-2178
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Provider Business Mailing Address
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Address Line | 17942 W POND RIDGE CIR
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City | GURNEE
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State | IL
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Zip | 60031-4534
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Country | US
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Telephone | 224-717-0447
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | ALEXANDER JAROSZ
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Credential |
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Telephone | 224-717-0447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209009332
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License Number State | IL
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