Healthcare Provider Details

I. General information

NPI: 1518696483
Provider Name (Legal Business Name): KYLE DAVID STENZEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 N LINCOLN AVE
CHICAGO IL
60657-1195
US

IV. Provider business mailing address

PO BOX 220
WESTMONT IL
60559-0220
US

V. Phone/Fax

Practice location:
  • Phone: 773-360-7287
  • Fax: 773-570-4843
Mailing address:
  • Phone: 708-590-6663
  • Fax: 708-469-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: