Provider Demographics
NPI:1336481548
Name:STANKIEWICZ, ANNA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIA
Last Name:STANKIEWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3529 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1049
Mailing Address - Country:US
Mailing Address - Phone:847-256-2041
Mailing Address - Fax:
Practice Address - Street 1:3529 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1049
Practice Address - Country:US
Practice Address - Phone:847-256-2041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063135208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice