Provider Demographics
NPI:1053312934
Name:STANKEVYCH, GEORGE LANE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LANE
Last Name:STANKEVYCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 HALIGUS RD
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9553
Mailing Address - Country:US
Mailing Address - Phone:815-356-2323
Mailing Address - Fax:847-802-7201
Practice Address - Street 1:4119 W SHAMROCK LN
Practice Address - Street 2:SUITE 200
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8289
Practice Address - Country:US
Practice Address - Phone:815-344-1611
Practice Address - Fax:815-344-1614
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-060937207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-060937OtherSTATE LICENSE
IL036-060937OtherSTATE LICENSE
ILL37513Medicare ID - Type Unspecified