Provider Demographics
NPI:1376626952
Name:GEORGE L STANKEVYCH MD PC
Entity Type:Organization
Organization Name:GEORGE L STANKEVYCH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:STANKEVYCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-344-1611
Mailing Address - Street 1:4119 W SHAMROCK LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8289
Mailing Address - Country:US
Mailing Address - Phone:815-344-1611
Mailing Address - Fax:815-344-1614
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5600259OtherBCBS
IL5600259OtherBCBS