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NPI Code Detail

MEDICARE: DR. STEPHANIE R BLACK M.D.

MEDICARE: DR. STEPHANIE R BLACK M.D.
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
1207R00000XInternal Medicine Physician036-097246IL
2207RI0200XInfectious Disease Physician036097246IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1440003692OTHERILRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316908791
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHANIE R BLACK M.D.
Provider Business Mailing Address
First Line : PO BOX 239D
Second Line :
City : PARK RIDGE
State : IL
Zip : 60068-8018
Country : US
Telephone Number : 847-759-1560
Fax Number : 847-803-1006
Provider Business Practice Location Address
First Line : 600 S PAULINA ST
Second Line : SUITE 143
City : CHICAGO
State : IL
Zip : 60612-3806
Country : US
Telephone Number : 312-942-2061
Fax Number : 312-942-2184
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2006
Last Update Date : 04/21/2021

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