Provider Demographics
NPI:1952318248
Name:MCCARTY, STACY (MD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:MCCARTY
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 1:355 E ERIE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3167
Mailing Address - Country:US
Mailing Address - Phone:312-238-1000
Mailing Address - Fax:
Practice Address - Street 1:7600 S COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6950
Practice Address - Country:US
Practice Address - Phone:630-388-6700
Practice Address - Fax:630-388-6777
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-102233208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102233Medicaid
ILP00052127OtherRAILROAD MEDICARE
ILP00052156OtherRAILROAD MEDICARE
ILL82105Medicare PIN
ILL82106Medicare PIN
IL036102233Medicaid
H26974Medicare UPIN