Individual
BRAD A. STOECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
401 N MAIN ST, ROANOKE, IL 61561-7516
(309) 923-2661
(309) 923-7628
Mailing address
401 N MAIN ST, ROANOKE, IL 61561-7516
(309) 923-2661
(309) 923-7628
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-116395
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036116395
—
IL
01
—
809840
MEDICARE GROUP #
IL
01
—
833230
GROUP # FOR PONTIAC
—
01
—
CA2182
RR MEDICARE GROUP PTAN (PONTIAC)
IL
01
—
CA4079
RR MEDICARE GROUP #
—
01
—
P00406153
RR MEDICARE IND. #
—
01
—
P00601872
RR MEDICARE IND PTAN (PONTIAC)
IL
Enumeration date
07/22/2006
Last updated
07/25/2008
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