Provider Demographics
NPI:1710133210
Name:STANLEY, TOM DAVIS (MD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:DAVIS
Last Name:STANLEY
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:PO BOX 735263
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7876
Practice Address - Country:US
Practice Address - Phone:815-398-9491
Practice Address - Fax:815-381-7498
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125166207X00000X, 207X00000X
IL036.125166207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCE6001OtherRAILROAD MEDICARE -
ILCG2631OtherRAILROAD MEDICARE - MCHENRY COUNTY
ILCE6001OtherRAILROAD MEDICARE -
ILCG2631OtherRAILROAD MEDICARE - MCHENRY COUNTY
IL207906Medicare Oscar/Certification
IL0354460002Medicare NSC
IL0354460004Medicare NSC
IL208821Medicare Oscar/Certification