Provider Demographics
NPI:1396824942
Name:STONE, LARRY STUART (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:STUART
Last Name:STONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4640 N MARINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-561-4545
Mailing Address - Fax:773-561-9031
Practice Address - Street 1:4640 N MARINE DRIVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-561-4545
Practice Address - Fax:773-561-9031
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063280207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063280Medicaid
IL036063280Medicaid
D13348Medicare UPIN