Provider Demographics
NPI:1982835740
Name:SCHILZ, STACY (PA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SCHILZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:SCHMITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:900 RAND RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2359
Mailing Address - Country:US
Mailing Address - Phone:847-324-3976
Mailing Address - Fax:847-929-1154
Practice Address - Street 1:350 S GREENLEAF ST STE 405
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5709
Practice Address - Country:US
Practice Address - Phone:847-336-3335
Practice Address - Fax:847-336-3249
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003515363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant