Provider Demographics
NPI:1003978032
Name:STRATFORD INTERNAL MEDICINE, SC
Entity Type:Organization
Organization Name:STRATFORD INTERNAL MEDICINE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-893-9660
Mailing Address - Street 1:290 SPRINGFIELD DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2214
Mailing Address - Country:US
Mailing Address - Phone:630-893-9660
Mailing Address - Fax:630-893-4180
Practice Address - Street 1:290 SPRINGFIELD DR
Practice Address - Street 2:SUITE 290
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2214
Practice Address - Country:US
Practice Address - Phone:630-893-9660
Practice Address - Fax:630-893-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC46137Medicare UPIN