Provider Demographics
NPI:1225102148
Name:STAMPLEY, ANDREA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:STAMPLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:GONZALEZ STAMPLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2224 WEBER RD
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403
Mailing Address - Country:US
Mailing Address - Phone:815-725-1600
Mailing Address - Fax:815-725-0300
Practice Address - Street 1:2224 WEBER RD
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403
Practice Address - Country:US
Practice Address - Phone:815-725-1600
Practice Address - Fax:815-725-0300
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9927691OtherBCBS
F78808Medicare UPIN