Provider Demographics
NPI:1679603302
Name:GUANDALINI, STEFANO (MD,)
Entity Type:Individual
Prefix:
First Name:STEFANO
Middle Name:
Last Name:GUANDALINI
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:UNIVERSITY OF CHICAGO, SECTION OF PEDS GASTRO
Mailing Address - Street 2:5839 SOUTH MARYLAND AVENUE, MC 4065
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1470
Mailing Address - Country:US
Mailing Address - Phone:773-702-6418
Mailing Address - Fax:773-702-0666
Practice Address - Street 1:UNIVERSITY OF CHICAGO, SECTION OF PEDS GASTRO
Practice Address - Street 2:5839 SOUTH MARYLAND AVENUE, MC 4065
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1470
Practice Address - Country:US
Practice Address - Phone:773-702-6418
Practice Address - Fax:773-702-0666
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2000092610Medicaid
ILL52742Medicare UPIN