Healthcare Provider Details

I. General information

NPI: 1710021100
Provider Name (Legal Business Name): STAVONNIE PATTERSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W RAND RD STE 210
ARLINGTON HEIGHTS IL
60004-2315
US

IV. Provider business mailing address

1051 W RAND RD STE 210
ARLINGTON HEIGHTS IL
60004-2315
US

V. Phone/Fax

Practice location:
  • Phone: 847-725-8401
  • Fax: 847-454-2236
Mailing address:
  • Phone: 847-725-8401
  • Fax: 847-454-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036.130964
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: