Basic Information
| Provider Information | |||||||||
| NPI: | 1407955214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMURTRY | ||||||||
| FirstName: | STACIE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9800 SHELBYVILLE RD | ||||||||
| Address2: | STE 220 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402232992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024298585 | ||||||||
| FaxNumber: | 8556567325 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 HOLLISTER DR STE 210 | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475497711 | ||||||||
| FaxNumber: | 8475491020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 09/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207KA0200X | 036092889 | IL | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | Allergy | 207K00000X | 036092889 | IL | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.