Provider Demographics
NPI:1598285165
Name:TICA, STEFANI STEVANIJA (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFANI
Middle Name:STEVANIJA
Last Name:TICA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 CHILDRENS PL CB 8116
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-6173
Mailing Address - Fax:314-454-2412
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6173
Practice Address - Fax:314-454-2412
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2021-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2020013471208000000X, 2080P0204X, 208M00000X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist