Healthcare Provider Details

I. General information

NPI: 1821036047
Provider Name (Legal Business Name): PETER J STECY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 N ASHLAND AVE
CHICAGO IL
60657-3014
US

IV. Provider business mailing address

3118 N ASHLAND AVE
CHICAGO IL
60657-3014
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-9722
  • Fax: 773-880-9723
Mailing address:
  • Phone: 773-880-9722
  • Fax: 773-880-9723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036073386
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: