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NPI Code Detail

MEDICARE: ROBERT R STACEY ATC

MEDICARE: ROBERT R STACEY ATC
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
12081S0010XSports Medicine (Physical Medicine & Rehabilitation) PhysicianIL

General Provider Information

NPI Number : 1639147929
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT R STACEY ATC
Provider Business Mailing Address
First Line : 8922 N WISNER ST
Second Line : APT. GE
City : NILES
State : IL
Zip : 60714-1764
Country : US
Telephone Number : 815-353-5579
Fax Number :
Provider Business Practice Location Address
First Line : 6000 W TOUHY AVE
Second Line : SUITE 202
City : CHICAGO
State : IL
Zip : 60646-1275
Country : US
Telephone Number : 773-774-4291
Fax Number : 773-774-4527
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 07/08/2007

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