Provider Demographics
NPI:1992902845
Name:TCHERNODRINSKI, STEFAN TOMOV (MD)
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:TOMOV
Last Name:TCHERNODRINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 S WOOD ST
Mailing Address - Street 2:ACADEMIC INTERNAL MEDICINE AND GERIATRICS
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-355-3433
Mailing Address - Fax:312-413-8283
Practice Address - Street 1:840 S WOOD ST
Practice Address - Street 2:ACADEMIC INTERNAL MEDICINE AND GERIATRICS
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-355-3433
Practice Address - Fax:312-413-8283
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036118008207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine