Provider Demographics
NPI:1164435293
Name:POLIT, STANLEY ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:ANTHONY
Last Name:POLIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13751 83RD AVENUE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-7007
Mailing Address - Country:US
Mailing Address - Phone:708-460-9346
Mailing Address - Fax:708-424-1799
Practice Address - Street 1:2850 WEST 95TH STREET
Practice Address - Street 2:SUITE 11
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805
Practice Address - Country:US
Practice Address - Phone:708-424-9044
Practice Address - Fax:708-424-1799
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036064603207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064603Medicaid
ILE24428Medicare UPIN
IL203155Medicare ID - Type Unspecified