Healthcare Provider Details

I. General information

NPI: 1437428786
Provider Name (Legal Business Name): MARK STEVEN STOLSPART FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4848 W IRVING PARK RD
CHICAGO IL
60641-2718
US

IV. Provider business mailing address

PO BOX 746715
ATLANTA GA
30374-6715
US

V. Phone/Fax

Practice location:
  • Phone: 773-724-6200
  • Fax:
Mailing address:
  • Phone: 773-724-6200
  • Fax: 773-866-8015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.009274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: