Provider Demographics
NPI:1801209556
Name:STUBBS, VANESSA CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:CHRISTINE
Last Name:STUBBS
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 1:1520 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3106
Mailing Address - Country:US
Mailing Address - Phone:312-942-6500
Mailing Address - Fax:312-942-6100
Practice Address - Street 1:1520 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3106
Practice Address - Country:US
Practice Address - Phone:312-942-6500
Practice Address - Fax:312-942-6100
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139084207Y00000X
NJ25MA10898200207Y00000X
PAMT206698390200000X
IL036165573207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program