Healthcare Provider Details

I. General information

NPI: 1235329749
Provider Name (Legal Business Name): ALICIA STOVELL, M.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8741 S GREENWOOD AVE STE 101
CHICAGO IL
60619-7058
US

IV. Provider business mailing address

8741 S GREENWOOD AVE STE 101
CHICAGO IL
60619-7058
US

V. Phone/Fax

Practice location:
  • Phone: 773-731-8460
  • Fax: 773-731-8461
Mailing address:
  • Phone: 773-731-8460
  • Fax: 773-731-8461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number036-082065
License Number StateIL

VIII. Authorized Official

Name: DR. ALICA ANN STOVELL
Title or Position: OWNER
Credential: MD, PC
Phone: 773-994-9440