Tack, Stanford
Tack, Stanford is an individual health care provider with primary practice located at 720 Florsheim Dr , Libertyville IL 60048-3757. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Tack, Stanford can be contacted via phone (847) 247-4000.Contact Information
Primary practice address
720 Florsheim Dr
Libertyville IL 60048-3757
Phone: (847) 247-4000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 036-075136 | Illinois |
Profile Details
| NPI number | 1558314013 |
|---|---|
| LBN Legal business name | Tack, Stanford |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 18th, 2006 |
| Last updated | Aug 28th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1558314013 | NPPES |
| Illinois | MEDICAID | 036-075136 |
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