Provider Demographics
NPI:1104323039
Name:STOBIERSKA, DOROTA (MD)
Entity type:Individual
Prefix:
First Name:DOROTA
Middle Name:
Last Name:STOBIERSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DOROTA
Other - Middle Name:MARTA
Other - Last Name:STOBIERSKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2403 41ST AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-3915
Mailing Address - Country:US
Mailing Address - Phone:646-410-5364
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-08
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.073004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine