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General NPI Number Information
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NPI Number | 1225006356
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Entity Type | Individual
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Provider Name | JAMES V STEPANICH ATC
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 11/04/2013
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Provider Practice Location Address
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Address Line | 1420 KENSINGTON RD SUITE 106
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City | OAK BROOK
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State | IL
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Zip | 60523-2143
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Country | US
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Telephone | 630-449-4638
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Fax | 630-449-4638
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Provider Business Mailing Address
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Address Line | 15W706 LEXINGTON ST
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City | ELMHURST
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State | IL
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Zip | 60126-5140
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Country | US
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Telephone | 630-279-9501
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096-000862
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License Number State | IL
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