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General NPI Number Information
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NPI Number | 1730701350
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Entity Type | Organization
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Legal Business Name | STEPHANIE MADDEN LLC
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 05/18/2020
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Provider Practice Location Address
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Address Line | 500 N DEARBORN ST STE 700
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City | CHICAGO
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State | IL
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Zip | 60654-3397
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Country | US
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Telephone | 630-631-1476
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Fax |
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Provider Business Mailing Address
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Address Line | 2675 W GRAND AVE APT 302
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City | CHICAGO
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State | IL
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Zip | 60612-1158
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Country | US
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Telephone | 630-631-1476
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Fax |
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | STEPHANIE MADDEN
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Credential |
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Telephone | 630-631-1476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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