Provider Demographics
NPI:1407275399
Name:JOANNA STANKIEWICZ MD SC
Entity Type:Organization
Organization Name:JOANNA STANKIEWICZ MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-205-8415
Mailing Address - Street 1:3800 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2718
Mailing Address - Country:US
Mailing Address - Phone:773-205-8415
Mailing Address - Fax:773-205-8436
Practice Address - Street 1:3800 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2718
Practice Address - Country:US
Practice Address - Phone:773-205-8415
Practice Address - Fax:773-205-8436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.620274174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-102753Medicaid
ILH16120Medicare UPIN