Provider Demographics
NPI:1154334159
Name:BAN, STACEY ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:ELLEN
Last Name:BAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9631 GROSS POINT RD
Mailing Address - Street 2:STE 10
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1264
Mailing Address - Country:US
Mailing Address - Phone:847-675-3900
Mailing Address - Fax:847-675-3930
Practice Address - Street 1:9631 GROSS POINT RD
Practice Address - Street 2:STE 10
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1264
Practice Address - Country:US
Practice Address - Phone:847-675-3900
Practice Address - Fax:847-675-3930
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2010-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036108968207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108968OtherSTATE LICENCE
IL036108968OtherSTATE LICENCE