Provider Demographics
NPI:1013039338
Name:STANLEY A POLIT MD, SC
Entity Type:Organization
Organization Name:STANLEY A POLIT MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:POLIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-424-9044
Mailing Address - Street 1:2850 W 95TH ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2735
Mailing Address - Country:US
Mailing Address - Phone:708-424-9044
Mailing Address - Fax:708-424-1799
Practice Address - Street 1:2850 W 95TH ST
Practice Address - Street 2:SUITE 11
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-424-9044
Practice Address - Fax:708-424-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064603207R00000X
207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21622753OtherBCBS
IL110238201OtherRR MEDICARE
IL21622753OtherBCBS