Provider Demographics
NPI:1497740393
Name:ISSLEIB, STUART A (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:A
Last Name:ISSLEIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3044
Mailing Address - Country:US
Mailing Address - Phone:630-336-7870
Mailing Address - Fax:
Practice Address - Street 1:5201 WILLOW SPRINGS RD STE 450
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6545
Practice Address - Country:US
Practice Address - Phone:630-336-7870
Practice Address - Fax:312-328-7986
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074032207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036074032Medicaid
IL110033745OtherRAILROAD MEDICARE
IL100009999OtherRAILROAD MEDICARE
IL31603503OtherBCBS PROVIDER ID
IL238276OtherWELLCARE HMO
IL100009999OtherRAILROAD MEDICARE
IL110033745OtherRAILROAD MEDICARE
IL110033745Medicare PIN
IL31603503OtherBCBS PROVIDER ID