Provider Demographics
NPI:1063933653
Name:MIGNANO, STEPHANIE R (DPM)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:MIGNANO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:R
Other - Last Name:FLORENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 W PARK
Mailing Address - Street 2:FAPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802
Mailing Address - Country:US
Mailing Address - Phone:217-902-6954
Mailing Address - Fax:217-902-7711
Practice Address - Street 1:611 W PARK
Practice Address - Street 2:FAPC
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802
Practice Address - Country:US
Practice Address - Phone:217-902-6954
Practice Address - Fax:217-902-7711
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006817213ES0103X
IL016006090213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist