Provider Demographics
NPI:1376521724
Name:STEFOSKI, DUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DUSAN
Middle Name:
Last Name:STEFOSKI
Suffix:
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 1:1725 W HARRISON
Mailing Address - Street 2:#309 UNIVERSITY NEUROLOGISTS MS CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3824
Mailing Address - Country:US
Mailing Address - Phone:312-942-8011
Mailing Address - Fax:312-563-4009
Practice Address - Street 1:1725 W HARRISON
Practice Address - Street 2:#309 UNIVERSITY NEUROLOGISTS MS CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3824
Practice Address - Country:US
Practice Address - Phone:312-942-8011
Practice Address - Fax:312-563-4009
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360517972084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCS336016711OtherIL DEPT OF PROG REGUL
IL036051797Medicaid
IL036051797Medicaid
ILL85562Medicare ID - Type Unspecified
IL036051797Medicaid