Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125.072452 | IL |
N | 111NI0900X | Internist | 125.072452 | IL |
Y | 207RA0201X | Internist - Allergy & Immunology | 036.155856 | IL |
NPI | 1225521776 |
---|---|
Provider Name | Ellen Daily Stephen |
First Address | Chicago, IL 60612-3848 |
Second Address | Chicago, IL 60612-3848 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2018 |
Last Update Date | 09/08/2021 |