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NPI Code Detail

MEDICARE: GEORGE PETER STACY JR. MD

MEDICARE: GEORGE PETER STACY JR. MD
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
1207RC0000XCardiovascular Disease Physician28751KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669471066
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGE PETER STACY JR. MD
Provider Business Mailing Address
First Line : PO BOX 776351
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6351
Country : US
Telephone Number : 502-592-7743
Fax Number : 502-272-5116
Provider Business Practice Location Address
First Line : 6420 DUTCHMANS PKWY STE 200
Second Line :
City : LOUISVILLE
State : KY
Zip : 40205-3373
Country : US
Telephone Number : 502-891-8300
Fax Number : 502-891-8338
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 03/05/2026

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