Healthcare Provider Details

I. General information

NPI: 1679710545
Provider Name (Legal Business Name): MEGHAN STAHULAK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 GROSS POINT RD
SKOKIE IL
60076-1214
US

IV. Provider business mailing address

4901 SEARLE PKWY
SKOKIE IL
60077-5313
US

V. Phone/Fax

Practice location:
  • Phone: 847-982-6710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.120659
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.120659
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: