Provider Demographics
NPI:1265443386
Name:STIPATI, KARLA (DPM)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:STIPATI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 DEAN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1068
Mailing Address - Country:US
Mailing Address - Phone:630-584-4200
Mailing Address - Fax:630-584-4257
Practice Address - Street 1:2320 DEAN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1068
Practice Address - Country:US
Practice Address - Phone:630-584-4200
Practice Address - Fax:630-584-4257
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004993213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL490033716OtherRAILROAD MEDICARE
IL480033716OtherRAILROAD MEDICARE
IL01632760OtherBCBS
IL016004993Medicaid
ILL91118Medicare PIN
IL480033716OtherRAILROAD MEDICARE
IL4755700001Medicare NSC
ILK08553Medicare PIN
IL490033716OtherRAILROAD MEDICARE