Healthcare Provider Details

I. General information

NPI: 1780622266
Provider Name (Legal Business Name): ALEKSANDRA STOBNICKI MD VIOLETA AVRAMOV MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE SUITE 427
CHICAGO IL
60631-3745
US

IV. Provider business mailing address

7447 W TALCOTT AVE SUITE 427
CHICAGO IL
60631-3745
US

V. Phone/Fax

Practice location:
  • Phone: 773-775-2323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALEKSANDRA STOBNICKI
Title or Position: MD/OWNER
Credential:
Phone: 773-775-2323