Provider Demographics
NPI:1508869744
Name:RICHTER, STASIA E (MD)
Entity Type:Individual
Prefix:
First Name:STASIA
Middle Name:E
Last Name:RICHTER
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 1:12632 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1428
Mailing Address - Country:US
Mailing Address - Phone:708-587-0000
Mailing Address - Fax:708-623-7628
Practice Address - Street 1:1725 W HARRISON ST STE 318
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3817
Practice Address - Country:US
Practice Address - Phone:312-942-6647
Practice Address - Fax:312-942-3730
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075143Medicaid
IL036075143Medicaid