Healthcare Provider Details

I. General information

NPI: 1174900997
Provider Name (Legal Business Name): STEPHANIE KALANT D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 OGDEN AVE STE 401
AURORA IL
60504-7208
US

IV. Provider business mailing address

2040 OGDEN AVE STE 401
AURORA IL
60504-7208
US

V. Phone/Fax

Practice location:
  • Phone: 630-499-6688
  • Fax: 630-499-6689
Mailing address:
  • Phone: 630-499-6688
  • Fax: 630-499-6689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036160759
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: