Healthcare Provider Details

I. General information

NPI: 1124935465
Provider Name (Legal Business Name): REBECCA STEPANEK
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 S DAMEN AVE
CHICAGO IL
60612-3727
US

IV. Provider business mailing address

3132 N CLIFTON AVE
CHICAGO IL
60657-3343
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number041511581
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: