Organization
FOX PRAIRIE MEDICAL GROUP P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STASIS KAHN M.D. (PARTNER)
(630) 513-8734
Entity
Organization
Contact information
Practice address
2560 FOXFIELD RD, SUITE 160, ST CHARLES, IL 60174-5797
(630) 513-8734
Mailing address
2560 FOXFIELD RD, SUITE 160, ST CHARLES, IL 60174-5797
(630) 513-8734
(630) 513-1199
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036075143
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036064522
—
IL
05
—
036075143
—
IL
05
—
036088803
—
IL
01
—
04532093
BLUE CROSS
IL
Enumeration date
04/02/2007
Last updated
11/09/2010
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