Healthcare Provider Details

I. General information

NPI: 1760131072
Provider Name (Legal Business Name): ALEXIS STEFANIAK-CLARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 N HAMMES AVE STE 1
JOLIET IL
60435-8145
US

IV. Provider business mailing address

219 N HAMMES AVE STE 1
JOLIET IL
60435-8145
US

V. Phone/Fax

Practice location:
  • Phone: 815-741-3220
  • Fax:
Mailing address:
  • Phone: 815-741-3220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.180649
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: