Individual
RAYMOND JEROME STADT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
12700 SACRAMENTO AVE, BLUE ISLAND, IL 60406-1822
(708) 597-6300
(708) 597-6386
Mailing address
20032 S MALLORY DR, FRANKFORT, IL 60423-9279
(630) 806-8347
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
IL
Other
Enumeration date
08/14/2006
Last updated
07/08/2007
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