Provider Demographics
NPI:1427087030
Name:STOSHAK-CHAVEZ, MARCIE L (MD)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:L
Last Name:STOSHAK-CHAVEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 WESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2908
Mailing Address - Country:US
Mailing Address - Phone:708-660-0885
Mailing Address - Fax:708-660-0234
Practice Address - Street 1:836 W WELLINGTON AVE
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE, AIMMC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5147
Practice Address - Country:US
Practice Address - Phone:773-296-7054
Practice Address - Fax:773-296-7818
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-076424207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine