Provider Demographics
NPI:1104880376
Name:STELLA, JOSEPH F (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:F
Last Name:STELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13011 S 104TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1508
Mailing Address - Country:US
Mailing Address - Phone:708-478-3600
Mailing Address - Fax:708-478-3552
Practice Address - Street 1:10260 191ST ST STE 102
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8802
Practice Address - Country:US
Practice Address - Phone:708-478-4224
Practice Address - Fax:708-478-4033
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081607207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL236551OtherMEDICARE GROUP
ILCN2703OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER
IL036081607Medicaid
IL1508810086OtherHEART CARE CENTERS OF ILLINOIS GROUP NPI
IL060066666OtherRAILROAD MEDICARE WILL
IL236550OtherMEDICARE GROUP
IL060066669OtherRAILROAD MEDICARE COOK
ILCG1672OtherRAILROAD MEDICARE GROUP PTAN NUMBER
IL01621208OtherBLUECROSS BLUE SHIELD
IL416810OtherMEDICARE GROUP
ILP00262173OtherRAILROAD MEDICARE KANKAKEE
IL01621208OtherBLUECROSS BLUE SHIELD
ILCG1672OtherRAILROAD MEDICARE GROUP PTAN NUMBER
G37573Medicare UPIN
ILL89785Medicare ID - Type Unspecified