Healthcare Provider Details

I. General information

NPI: 1548826571
Provider Name (Legal Business Name): STEPHANIE ATOYEBI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SUPERIOR ST # 405
MELROSE PARK IL
60160-4138
US

IV. Provider business mailing address

1111 SUPERIOR ST # 405
MELROSE PARK IL
60160-4138
US

V. Phone/Fax

Practice location:
  • Phone: 773-729-2329
  • Fax: 949-703-7790
Mailing address:
  • Phone: 773-729-2329
  • Fax: 949-703-7790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number135001065
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number016005943
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: