MEDICARE: JAMES STIM MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	036078891	IL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00605029	OTHER	IL	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1616108	OTHER	IL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1104827427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES STIM MD

Provider Business Mailing Address
First Line	:	612 ROXBURY RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5089
Country	:	US
Telephone Number	:	815-227-8300
Fax Number	:	815-227-8301

Provider Business Practice Location Address
First Line	:	612 ROXBURY RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5089
Country	:	US
Telephone Number	:	815-227-8300
Fax Number	:	815-227-8301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	04/22/2011

622 ROXBURY RD
ROCKFORD, IL
61107-5089

Practice Phone: 815-397-0713
Practice Fax: 815-397-0796

612 ROXBURY RD
ROCKFORD, IL
61107-5089