MEDICARE: JOANNA STANKIEWICZ MD SC

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	174400000X	Specialist	042.620274	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1407275399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANNA STANKIEWICZ MD SC

Provider Business Mailing Address
First Line	:	3800 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2718
Country	:	US
Telephone Number	:	773-205-8415
Fax Number	:	773-205-8436

Provider Business Practice Location Address
First Line	:	3800 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2718
Country	:	US
Telephone Number	:	773-205-8415
Fax Number	:	773-205-8436

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	DR. JOANNA STANKIEWICZ
Credential	:	M.D.
Telephone Number	:	773-205-8415

Provider Enumeration Date	:	04/08/2014
Last Update Date	:	04/08/2014

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