Provider Demographics
NPI:1982716932
Name:STAMELOS, JOHN N (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:N
Last Name:STAMELOS
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 1:600 W LAKE COOK RD
Mailing Address - Street 2:#160
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-2091
Mailing Address - Country:US
Mailing Address - Phone:847-520-8900
Mailing Address - Fax:
Practice Address - Street 1:600 W LAKE COOK RD
Practice Address - Street 2:#160
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2091
Practice Address - Country:US
Practice Address - Phone:847-520-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060882207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619562OtherBC/BS
200016715OtherMEDICARE RAILROAD
IL036060882Medicaid
IL036060882Medicaid
200016715OtherMEDICARE RAILROAD
ILL29261Medicare PIN