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NPI Code Detail

MEDICARE: DR. STEPHANIE ANN HERATY MD

MEDICARE: DR. STEPHANIE ANN HERATY MD
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
1207V00000XObstetrics & Gynecology Physician036.119864IL

General Provider Information

NPI Number : 1972767895
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHANIE ANN HERATY MD
Provider Business Mailing Address
First Line : 2801 LAKESIDE DR STE 209
Second Line :
City : BANNOCKBURN
State : IL
Zip : 60015-1271
Country : US
Telephone Number : 847-562-1410
Fax Number : 847-562-0830
Provider Business Practice Location Address
First Line : 1000 CENTRAL ST STE 700
Second Line :
City : EVANSTON
State : IL
Zip : 60201-1769
Country : US
Telephone Number : 847-869-3300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2008
Last Update Date : 01/24/2020

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Directions to “ DR. STEPHANIE ANN HERATY MD” Practice Location

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