Healthcare Provider Details

I. General information

NPI: 1952330607
Provider Name (Legal Business Name): JULIE KIM STAMOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

695 HILL RD
WINNETKA IL
60093-3914
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-4317
  • Fax: 773-880-8226
Mailing address:
  • Phone: 847-784-8993
  • Fax: 847-784-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number036079115
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: