Healthcare Provider Details

I. General information

NPI: 1821023789
Provider Name (Legal Business Name): CHRISTIANE ELLEN STAHL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST DEPT OF PEDIATRICS, M/C 857
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

914 W FLETCHER ST
CHICAGO IL
60657-4499
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-4957
  • Fax:
Mailing address:
  • Phone: 773-935-8160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: