Provider Demographics
NPI:1710998315
Name:STEPHENSON, MARY DIANE (MD, MSC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:DIANE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:MD, MSC
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Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:MC 2050
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-834-2363
Mailing Address - Fax:773-702-2893
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-9200
Practice Address - Fax:773-702-2893
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology