Healthcare Provider Details

I. General information

NPI: 1275726564
Provider Name (Legal Business Name): DESTEFANO&STAMAT PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 W COLLEGE DR SUITE B
PALOS HEIGHTS IL
60463-1026
US

IV. Provider business mailing address

7550 W COLLEGE DR SUITE B
PALOS HEIGHTS IL
60463-1026
US

V. Phone/Fax

Practice location:
  • Phone: 708-923-6262
  • Fax: 708-923-6868
Mailing address:
  • Phone: 708-923-6262
  • Fax: 708-923-6868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. PENNY STAMAT
Title or Position: OFFICE MANAGER
Credential:
Phone: 708-923-6262