Basic Information
| Provider Information | |||||||||
| NPI: | 1013039338 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STANLEY A POLIT MD, SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2850 W 95TH ST | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | EVERGREEN PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 608052735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084249044 | ||||||||
| FaxNumber: | 7084241799 | ||||||||
| Practice Location | |||||||||
| Address1: | 2850 W 95TH ST | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | EVERGREEN PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 608052735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084249044 | ||||||||
| FaxNumber: | 7084241799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 10/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | POLIT | ||||||||
| AuthorizedOfficialFirstName: | STANLEY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 7084249044 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036064603 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 21622753 | 01 | IL | BCBS | OTHER | 110238201 | 01 | IL | RR MEDICARE | OTHER |