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NPI Code Detail

MEDICARE: MARK STAHMANN

MEDICARE: MARK STAHMANN
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
1183500000XPharmacist051286334IL

General Provider Information

NPI Number : 1790061125
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK STAHMANN
Provider Business Mailing Address
First Line : 7209 W LINCOLN HWY
Second Line :
City : FRANKFORT
State : IL
Zip : 60423-6021
Country : US
Telephone Number : 815-464-8374
Fax Number : 815-464-8387
Provider Business Practice Location Address
First Line : 7209 W LINCOLN HWY
Second Line :
City : FRANKFORT
State : IL
Zip : 60423-6021
Country : US
Telephone Number : 815-464-8374
Fax Number : 815-464-8387
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2011
Last Update Date : 10/31/2011

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Directions to “ MARK STAHMANN ” Practice Location

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