Provider Demographics
NPI:1467089177
Name:MATHEWS, STACY KOLLANUR (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:KOLLANUR
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 N ARLINGTON HEIGHTS RD STE 409&410
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7709
Mailing Address - Country:US
Mailing Address - Phone:224-857-8000
Mailing Address - Fax:327-540-9600
Practice Address - Street 1:3275 N ARLINGTON HEIGHTS RD STE 409&410
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7709
Practice Address - Country:US
Practice Address - Phone:224-857-8000
Practice Address - Fax:327-540-9600
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1659880698208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty