Provider Demographics
NPI:1922666890
Name:BEARD, STEFANI ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:STEFANI
Middle Name:ELIZABETH
Last Name:BEARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2631
Mailing Address - Country:US
Mailing Address - Phone:312-942-6777
Mailing Address - Fax:
Practice Address - Street 1:839 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2631
Practice Address - Country:US
Practice Address - Phone:312-942-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102207142207Q00000X
IL036159680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty