Healthcare Provider Details

I. General information

NPI: 1295756344
Provider Name (Legal Business Name): STEPHEN SALVATORE STABILE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 N WESTERN AVE
CHICAGO IL
60622-1797
US

IV. Provider business mailing address

5245 N MAGNOLIA AVE
CHICAGO IL
60640-2202
US

V. Phone/Fax

Practice location:
  • Phone: 312-633-5841
  • Fax: 312-491-5020
Mailing address:
  • Phone: 773-671-5178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-083665
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: