MEDICARE: DESTEFANO&STAMAT PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275726564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESTEFANO&STAMAT PEDIATRICS

Provider Business Mailing Address
First Line	:	7550 W COLLEGE DR
Second Line	:	SUITE B
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1026
Country	:	US
Telephone Number	:	708-923-6262
Fax Number	:	708-923-6868

Provider Business Practice Location Address
First Line	:	7550 W COLLEGE DR
Second Line	:	SUITE B
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1026
Country	:	US
Telephone Number	:	708-923-6262
Fax Number	:	708-923-6868

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. PENNY STAMAT
Credential	:
Telephone Number	:	708-923-6262

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	06/27/2016

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Directions to “DESTEFANO&STAMAT PEDIATRICS ” Practice Location

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