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General NPI Number Information
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NPI Number | 1235329749
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Entity Type | Organization
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Legal Business Name | ALICIA STOVELL, M.D. PC
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 8741 S GREENWOOD AVE STE 101
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City | CHICAGO
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State | IL
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Zip | 60619-7058
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Country | US
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Telephone | 773-731-8460
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Fax | 773-731-8461
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Provider Business Mailing Address
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Address Line | 8741 S GREENWOOD AVE STE 101
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City | CHICAGO
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State | IL
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Zip | 60619-7058
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Country | US
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Telephone | 773-731-8460
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Fax | 773-731-8461
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALICA ANN STOVELL
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Credential | MD, PC
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Telephone | 773-994-9440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 036-082065
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License Number State | IL
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