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NPI Code Detail

MEDICARE: MICHAEL DESTEFANO M.D. S.C.

MEDICARE: MICHAEL DESTEFANO M.D. S.C.
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
1208000000XPediatrics Physician

General Provider Information

NPI Number : 1801082870
Entity Type Code : Organization
Provider Name (Legal Business Name) : MICHAEL DESTEFANO M.D. S.C.
Provider Business Mailing Address
First Line : 12504 SOUTHWEST HWY
Second Line :
City : PALOS PARK
State : IL
Zip : 60464-1851
Country : US
Telephone Number : 708-214-9281
Fax Number : 708-361-2742
Provider Business Practice Location Address
First Line : 7000 W 111TH ST
Second Line :
City : WORTH
State : IL
Zip : 60482-1851
Country : US
Telephone Number : 708-214-9281
Fax Number : 708-361-2742
Authorized Official
Title or Position : PRESIDENT
Name : MICHAEL D. DESTEFANO
Credential : M.D.
Telephone Number : 708-214-9281
Provider Enumeration Date : 09/24/2007
Last Update Date : 09/24/2007

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