Provider Demographics
NPI:1851386221
Name:STOCKTON, DONNA L (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:STOCKTON
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 1:19639 LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9360
Mailing Address - Country:US
Mailing Address - Phone:708-478-3530
Mailing Address - Fax:708-478-3537
Practice Address - Street 1:19639 LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9360
Practice Address - Country:US
Practice Address - Phone:708-478-3530
Practice Address - Fax:708-478-3537
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL903280Medicare ID - Type Unspecified
E21596Medicare UPIN