Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
STACEY ANNE BENNIS, M.D., CAQ-SM
ActiveSTACEY ANNE BENNIS, M.D., CAQ-SM is a Sports Medicine (PM&R) healthcare provider located in MAYWOOD, Illinois. NPI 1265870695 is currently active in the NPPES registry. Verify at CMS.
Sports Medicine (PM&R) · MAYWOOD, IL
Registration Details
- NPI Number
- 1265870695
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jun 7, 2013 (13.226670627758 yrs)
- Last Updated
- Oct 25, 2020
- Licenses
-
125-063353 (IL)036146120 (IL)
Practice Information
- Address
-
2160 S 1ST AVE STE 1700MAYWOOD, IL, 601533328Browse IL providers · Browse ZIP 60153
- Phone
- 8885847888
- Primary Specialty
-
Sports Medicine (PM&R)
2081S0010X
- Additional Specialty
- Sports Medicine (PM&R)
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.