Provider Demographics
NPI:1760495113
Name:TOMCZYK, STANLEY G (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:G
Last Name:TOMCZYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3315 ALGONQUIN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3257
Mailing Address - Country:US
Mailing Address - Phone:847-788-0700
Mailing Address - Fax:847-788-0703
Practice Address - Street 1:3315 ALGONQUIN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3257
Practice Address - Country:US
Practice Address - Phone:847-788-0700
Practice Address - Fax:847-788-0703
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-083434207QG0300X
IL336-045720207QA0401X
IL036083434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA96623Medicare UPIN