Healthcare Provider Details

I. General information

NPI: 1548291578
Provider Name (Legal Business Name): STEFANIE SPANIER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEFANIE SPANIER-MINGOLELLI M.D.

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST SUITE 710
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

5611 DORAL DR
SARASOTA FL
34243-3840
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-3034
  • Fax:
Mailing address:
  • Phone: 708-646-7413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-084045
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036084045
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: