Basic Information
| Provider Information | |||||||||
| NPI: | 1164435293 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POLIT | ||||||||
| FirstName: | STANLEY | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13751 83RD AVENUE | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604627007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084609346 | ||||||||
| FaxNumber: | 7084241799 | ||||||||
| Practice Location | |||||||||
| Address1: | 2850 WEST 95TH STREET | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | EVERGREEN PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084249044 | ||||||||
| FaxNumber: | 7084241799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 07/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036064603 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 036064603 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 036064603 | 05 | IL | MEDICAID |