MEDICARE: JOHN E. STOPKA M.D. S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1093008427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN E. STOPKA M.D. S.C.

Provider Business Mailing Address
First Line	:	6918 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2337
Country	:	US
Telephone Number	:	773-586-4700
Fax Number	:	773-586-4711

Provider Business Practice Location Address
First Line	:	6918 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2337
Country	:	US
Telephone Number	:	773-586-4700
Fax Number	:	773-586-4711

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. JOHN STOPKA
Credential	:	M.D.
Telephone Number	:	773-586-4700

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	09/19/2011

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