Healthcare Provider Details

I. General information

NPI: 1679718654
Provider Name (Legal Business Name): STACEY MICHELLE DIPALMA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E HURON ST FL 13
CHICAGO IL
60611-2999
US

IV. Provider business mailing address

150 E HURON ST
CHICAGO IL
60611-2999
US

V. Phone/Fax

Practice location:
  • Phone: 312-540-9955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number257188
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: