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NPI Code Detail

MEDICARE: STEPHANIE TRACEY PA

MEDICARE: STEPHANIE TRACEY PA
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
1363A00000XPhysician Assistant085-001077IL

General Provider Information

NPI Number : 1275622888
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE TRACEY PA
Provider Business Mailing Address
First Line : 550 E DEVON AVE STE 200
Second Line :
City : ITASCA
State : IL
Zip : 60143-2639
Country : US
Telephone Number : 864-625-3376
Fax Number :
Provider Business Practice Location Address
First Line : 550 E DEVON AVE STE 200
Second Line :
City : ITASCA
State : IL
Zip : 60143-2639
Country : US
Telephone Number : 864-625-3376
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 03/09/2022

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Directions to “ STEPHANIE TRACEY PA” Practice Location

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