Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 036-145200 | IL |
N | 207VX0201X | Gynecologic Oncologist | MD-41735 | IA |
NPI | 1316147192 |
---|---|
Provider Name | Jean-Marie Stephan |
First Address | Chicago, IL 60612-3841 |
Second Address | Chicago, IL 60612-3841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 27/09/2018 |