IndividualActive
Stacey Bennis, M.D., CAQ-SM
NPI 1265870695 · Sports Medicine (Physical Medicine & Rehabilitation) Physician · Maywood, IL
Provider details
- NPI number
- 1265870695
- Entity type
- Individual
- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) PhysicianAllopathic & Osteopathic Physicians
- Credential
- M.D., CAQ-SM
- Sex
- Female
- Sole proprietor
- No
- License
- 125-063353 (IL)
Specialties & taxonomies
- Sports Medicine (Physical Medicine & Rehabilitation) PhysicianPrimary2081S0010XLicense 036146120 (IL)
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
2160 S 1st Ave Ste 1700
Maywood, IL 60153-3328
Phone: (888) 584-7888
Approximate (ZIP-level) locationGet directions
Mailing address
2160 S 1st Ave Ste 1700
Maywood, IL 60153-3328
Registry dates
- Enumerated
- 2013-06-07
- Last updated
- 2020-10-25
- Certified
- 2020-10-25
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.