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NPI Code Detail

MEDICARE: DR. JOHN ROLFE STUTESMAN PSYD

MEDICARE: DR. JOHN ROLFE STUTESMAN PSYD
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
1103TC0700XClinical PsychologistIL

General Provider Information

NPI Number : 1740363753
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN ROLFE STUTESMAN PSYD
Provider Business Mailing Address
First Line : 1012 W FRY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60622-5418
Country : US
Telephone Number : 312-802-1500
Fax Number :
Provider Business Practice Location Address
First Line : 737 N MICHIGAN AVE STE 2130
Second Line :
City : CHICAGO
State : IL
Zip : 60611-6747
Country : US
Telephone Number : 312-802-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 07/08/2007

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