Provider Demographics
NPI:1770518946
Name:STANLEY, ROBERT E (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:STANLEY
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 1:9650 GROSS POINT RD
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1234
Mailing Address - Country:US
Mailing Address - Phone:847-676-1112
Mailing Address - Fax:847-674-3358
Practice Address - Street 1:9650 GROSS POINT RD
Practice Address - Street 2:SUITE 1900
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1234
Practice Address - Country:US
Practice Address - Phone:847-676-1112
Practice Address - Fax:847-674-3358
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01633513OtherBCBS
E51029Medicare UPIN
IL188293Medicare ID - Type Unspecified