Provider Demographics
NPI:1205821733
Name:STEFANI, RONALD H JR (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:H
Last Name:STEFANI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3341
Mailing Address - Country:US
Mailing Address - Phone:630-495-1000
Mailing Address - Fax:630-495-8545
Practice Address - Street 1:629 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3341
Practice Address - Country:US
Practice Address - Phone:630-495-1000
Practice Address - Fax:630-495-8545
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE35046Medicare UPIN
IL708410Medicare ID - Type Unspecified