Provider Demographics
NPI:1780470039
Name:POUPART, STEFFANY (MD)
Entity type:Individual
Prefix:
First Name:STEFFANY
Middle Name:
Last Name:POUPART
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:STEFFANY
Other - Middle Name:IDA MARIE
Other - Last Name:POUPART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6150 AVE DU BOISE
Mailing Address - Street 2:APT 6C
Mailing Address - City:MONTREAL
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:J0R 1R2
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 EAST CHICAGO AVENUE BOX 107
Practice Address - Street 2:DIVISION OF DERMATOLOGY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-227-6060
Practice Address - Fax:312-227-9402
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program