Healthcare Provider Details

I. General information

NPI: 1932634003
Provider Name (Legal Business Name): BRIAN JAMES STOJAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5346 N CLARK ST
CHICAGO IL
60640-2120
US

IV. Provider business mailing address

5346 N CLARK ST
CHICAGO IL
60640-2120
US

V. Phone/Fax

Practice location:
  • Phone: 773-293-8880
  • Fax: 773-293-8843
Mailing address:
  • Phone: 773-293-8880
  • Fax: 773-293-8843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036152245
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: