Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 016005295 | IL |
NPI | 1063425361 |
---|---|
Provider Name | Dr. Stacey L Oaks |
First Address | Chicago, IL 60611-3926 |
Second Address | Chicago, IL 60611-3926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 11/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001621735 | BLUE CROSS BLUE SHIELD (01) | IL |
016005295 | (05) | IL |
P00732457 | RAILROAD MEDICARE (01) | IL |