Provider Demographics
NPI:1679573356
Name:FRONCZAK, STANLEY WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:WALTER
Last Name:FRONCZAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:700 E OGDEN AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1283
Mailing Address - Country:US
Mailing Address - Phone:630-655-1229
Mailing Address - Fax:630-655-0185
Practice Address - Street 1:700 E OGDEN AVE STE 106
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1283
Practice Address - Country:US
Practice Address - Phone:630-655-1229
Practice Address - Fax:630-655-0185
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051071207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL29022Medicare PIN
C44801Medicare UPIN