Provider Demographics
NPI:1063779270
Name:CERMAK, STEPHANIE J (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:J
Last Name:CERMAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:DENNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C PHYSICIAN ASSIS
Mailing Address - Street 1:2850 W. 95TH STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805
Mailing Address - Country:US
Mailing Address - Phone:708-424-7600
Mailing Address - Fax:708-424-7605
Practice Address - Street 1:2850 W. 95TH STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805
Practice Address - Country:US
Practice Address - Phone:708-424-7600
Practice Address - Fax:708-424-7605
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.004228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant