Provider Demographics
NPI:1922193994
Name:STONER, JOHN ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALBERT
Last Name:STONER
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 1:2 E 22ND ST
Mailing Address - Street 2:STE 306
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4976
Mailing Address - Country:US
Mailing Address - Phone:630-376-6317
Mailing Address - Fax:
Practice Address - Street 1:2 E 22ND ST
Practice Address - Street 2:STE 306
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4976
Practice Address - Country:US
Practice Address - Phone:630-376-6317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043219Medicaid
ILK03840Medicare ID - Type Unspecified
ILA01219Medicare UPIN