Healthcare Provider Details

I. General information

NPI: 1215314174
Provider Name (Legal Business Name): COURTNEY JEAN STEFANSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26W171 ROOSEVELT RD
WHEATON IL
60187-6002
US

IV. Provider business mailing address

225 W HURON ST APT 309
CHICAGO IL
60654-3903
US

V. Phone/Fax

Practice location:
  • Phone: 630-909-8000
  • Fax:
Mailing address:
  • Phone: 847-804-8161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036149824
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: