1487092458 NPI number — MR. ELIZABETH CUTRARA STAMER

Table of content: MR. ELIZABETH CUTRARA STAMER (NPI 1487092458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487092458 NPI number — MR. ELIZABETH CUTRARA STAMER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAMER
Provider First Name:
ELIZABETH
Provider Middle Name:
CUTRARA
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487092458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 N STONE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA GRANGE PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60526-1817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-715-6852
Provider Business Mailing Address Fax Number:
708-579-5642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
527 N ASHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60526-5604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-715-6852
Provider Business Practice Location Address Fax Number:
708-579-5642
Provider Enumeration Date:
06/11/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 1-18-33376 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)