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General NPI Number Information
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NPI Number | 1770819708
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Entity Type | Individual
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Provider Name | STACEY L CARPENTER DO
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Gender | Female
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 6150 JOLIET RD
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-3956
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Country | US
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Telephone | 708-485-2273
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Fax | 708-352-0845
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Provider Business Mailing Address
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Address Line | 6150 JOLIET RD
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-3956
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Country | US
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Telephone | 708-485-2273
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Fax | 708-352-0845
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036134169
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License Number State | IL
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