Provider Demographics
NPI:1235329749
Name:ALICIA STOVELL, M.D. PC
Entity Type:Organization
Organization Name:ALICIA STOVELL, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:773-994-9440
Mailing Address - Street 1:8741 S GREENWOOD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-7058
Mailing Address - Country:US
Mailing Address - Phone:773-731-8460
Mailing Address - Fax:773-731-8461
Practice Address - Street 1:8741 S GREENWOOD AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-7058
Practice Address - Country:US
Practice Address - Phone:773-731-8460
Practice Address - Fax:773-731-8461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-082065302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL428000Medicare PIN