MEDICARE: DR. DEBRA BETH STULBERG 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
1	207Q00000X	Family Medicine Physician	036-112006	IL

General Provider Information

NPI Number	:	1689774283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBRA BETH STULBERG M.D.

Provider Business Mailing Address
First Line	:	5841 S MARYLAND AVE # MC7110
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-834-1356
Fax Number	:

Provider Business Practice Location Address
First Line	:	5843 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-1526
Country	:	US
Telephone Number	:	773-434-8600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	06/27/2013

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