Provider Demographics
NPI:1750612743
Name:RONALD H STEFANI JR MD FACS SC
Entity type:Organization
Organization Name:RONALD H STEFANI JR MD FACS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:STEFANI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:630-495-1000
Mailing Address - Street 1:629 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3341
Mailing Address - Country:US
Mailing Address - Phone:630-495-1000
Mailing Address - Fax:630-495-8545
Practice Address - Street 1:629 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3341
Practice Address - Country:US
Practice Address - Phone:630-495-1000
Practice Address - Fax:630-495-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-071336208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-071336OtherIL LICENSE NUMBER
IL036-071336OtherIL LICENSE NUMBER