Provider Demographics
NPI:1629029038
Name:SYMANSKI, STACY A (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:A
Last Name:SYMANSKI
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 1:2 PRUDENTIAL PLAZA
Mailing Address - Street 2:SUITE 3175
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:312-565-1600
Mailing Address - Fax:844-272-6197
Practice Address - Street 1:2 PRUDENTIAL PLAZA
Practice Address - Street 2:SUITE 3175
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:312-565-1600
Practice Address - Fax:844-272-6197
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102757207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31601613OtherBLUE CROSS BLUE SHIELD
ILIL2757OtherEYEMED
IL036102757Medicaid
IL2246937OtherUNITED HEALTHCARE
IL2977114OtherAETNA
ILH19727Medicare UPIN
ILL94137Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER