Black, Stephanie R

Black, Stephanie R is an individual health care provider with primary practice located at 600 S Paulina St Suite 143, Chicago IL 60612-3806. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Infectious Disease. Allopathic & Osteopathic Physicians / Infectious Disease is her primary health care specialty. Black, Stephanie R can be contacted via phone (312) 942-2061.

Contact Information

Primary practice address
600 S Paulina St Suite 143 Chicago IL 60612-3806
Phone: (312) 942-2061
Fax: (312) 942-2184
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 036-097246 Illinois
Allopathic & Osteopathic Physicians / Infectious Disease 207RI0200X 036097246 Illinois

Profile Details

NPI number 1316908791
LBN Legal business name Black, Stephanie R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 28th, 2006
Last updated Apr 21st, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316908791 NPPES
Illinois Other 440003692 RR MEDICARE
Illinois MEDICAID 036097246 RR MEDICARE

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