Healthcare Provider Details

I. General information

NPI: 1588156392
Provider Name (Legal Business Name): KRISTINA ELIZABETH STIBITZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 GATEWAY DR
SYCAMORE IL
60178-3192
US

IV. Provider business mailing address

1850 GATEWAY DR
SYCAMORE IL
60178-3192
US

V. Phone/Fax

Practice location:
  • Phone: 815-758-8671
  • Fax: 815-758-7460
Mailing address:
  • Phone: 815-758-8671
  • Fax: 815-758-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036157078
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: