Provider Demographics
NPI:1356399737
Name:STEPHANI, RICK W (MD)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:W
Last Name:STEPHANI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 87904
Mailing Address - Street 2:MEA ELK GROVE LLC DEPT 2049
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-7904
Mailing Address - Country:US
Mailing Address - Phone:630-734-0200
Mailing Address - Fax:630-734-1560
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:ALEXIAN BROTHERS MEDICAL CENTER
Practice Address - City:ELK GROVE VLG
Practice Address - State:IL
Practice Address - Zip Code:60007-3311
Practice Address - Country:US
Practice Address - Phone:847-437-5500
Practice Address - Fax:630-734-1560
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IL207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F16040Medicare UPIN
ILK08224Medicare ID - Type Unspecified