| Organization Name: | B C STUFFLEBAM, MD, LLC |
| NPI Number: | 1043453707 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRADLEY CHRISTIAN STUFFLEBAM (MANAGER) |
| Mailing Address: | 629 Sable Dr Centralia |
| State: | IL US |
| Postal Code: | 628014472 |
| Phone Number: | 6185330727 |
| Fax Number: | 6185331464 |
| NPI Enumeration Date: | 04/10/2009 |
| NPI Last Update Date: | 04/10/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | 036058847 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |