Provider Demographics
NPI:1750645263
Name:STONE, SCHUYLER WHITNEY
Entity Type:Individual
Prefix:DR
First Name:SCHUYLER
Middle Name:WHITNEY
Last Name:STONE
Suffix:
Gender:M
Credentials:
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 19636
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9636
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:217-545-7127
Practice Address - Street 1:701 NORTH 1ST STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62794-9636
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-545-7127
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.137864207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036137864Medicaid
ILF400222472Medicare PIN