Individual
STACY A BAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
552 RANDALL RD, SOUTH ELGIN, IL 60177
(630) 315-6700
(630) 315-6699
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 315-6700
(630) 315-6699
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003350
IL
363AM0700X
Medical Physician Assistant
085.003350
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
920540
GROUP MEDICARE
IL
01
—
F400473831
INDIVIDUAL MEDICARE
IL
Enumeration date
11/17/2008
Last updated
06/18/2018
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