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NPI Code Detail

MEDICARE: REBECCA STACK

MEDICARE: REBECCA STACK
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery Podiatrist016005891IL

General Provider Information

NPI Number : 1164955746
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA STACK
Provider Business Mailing Address
First Line : 1721 E 19TH AVE STE 520
Second Line :
City : DENVER
State : CO
Zip : 80218-1243
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 113 W MAIN ST
Second Line :
City : CARY
State : IL
Zip : 60013-2718
Country : US
Telephone Number : 847-639-5800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2017
Last Update Date : 12/20/2021

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Directions to “ REBECCA STACK ” Practice Location

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