Healthcare Provider Details

I. General information

NPI: 1831431386
Provider Name (Legal Business Name): STEPHANIE LABEDZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST 440 CSN, MC 718
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

840 S WOOD ST ROOM 920-N CSB
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7836
  • Fax: 312-413-8283
Mailing address:
  • Phone: 312-996-8039
  • Fax: 312-996-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036139126
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036139126
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: