Provider Demographics
NPI:1225009947
Name:STEFANCIC, MICHAEL FLORIAN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FLORIAN
Last Name:STEFANCIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:55 E WASHINGTON ST
Mailing Address - Street 2:SUITE 3604
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2103
Mailing Address - Country:US
Mailing Address - Phone:312-553-9620
Mailing Address - Fax:312-553-9621
Practice Address - Street 1:55 E WASHINGTON ST
Practice Address - Street 2:SUITE 3604
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2103
Practice Address - Country:US
Practice Address - Phone:312-553-9620
Practice Address - Fax:312-553-9621
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42115Medicare UPIN
IL482100Medicare PIN