Healthcare Provider Details

I. General information

NPI: 1679603302
Provider Name (Legal Business Name): STEFANO GUANDALINI M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF CHICAGO, SECTION OF PEDS GASTRO 5839 SOUTH MARYLAND AVENUE, MC 4065
CHICAGO IL
60637-1470
US

IV. Provider business mailing address

UNIVERSITY OF CHICAGO, SECTION OF PEDS GASTRO 5839 SOUTH MARYLAND AVENUE, MC 4065
CHICAGO IL
60637-1470
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6418
  • Fax: 773-702-0666
Mailing address:
  • Phone: 773-702-6418
  • Fax: 773-702-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: