Healthcare Provider Details

I. General information

NPI: 1477624120
Provider Name (Legal Business Name): ALICIA ANN STOVELL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8541 S STATE ST
CHICAGO IL
60619-5665
US

IV. Provider business mailing address

8541 S. STATE ST.
CHICAGO IL
60619
US

V. Phone/Fax

Practice location:
  • Phone: 773-994-9440
  • Fax: 773-994-8166
Mailing address:
  • Phone: 773-994-9440
  • Fax: 773-994-8166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: