Provider Demographics
NPI:1023544186
Name:MAZUR, STEPHANY LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANY
Middle Name:LYNNE
Last Name:MAZUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANY
Other - Middle Name:LYNNE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 E SUPERIOR ST STE 4-2304
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2914
Mailing Address - Country:US
Mailing Address - Phone:312-472-0436
Mailing Address - Fax:312-472-0480
Practice Address - Street 1:250 E SUPERIOR ST STE 4-2304
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-472-0436
Practice Address - Fax:312-472-0480
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.0710262085R0202X
IL0361600772085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology