Healthcare Provider Details

I. General information

NPI: 1780470039
Provider Name (Legal Business Name): STEFFANY POUPART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEFFANY IDA MARIE POUPART

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EAST CHICAGO AVENUE BOX 107 DIVISION OF DERMATOLOGY
CHICAGO IL
60611
US

IV. Provider business mailing address

6150 AVE DU BOISE APT 6C
MONTREAL QUEBEC
J0R 1R2
CA

V. Phone/Fax

Practice location:
  • Phone: 312-227-6060
  • Fax: 312-227-9402
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: