Individual
AIDAN KENNEDY STAVROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1611 W HARRISON ST STE 400, CHICAGO, IL 60612-4861
(877) 632-6637
(708) 409-5179
Mailing address
PO BOX 735263, CHICAGO, IL 60673-5263
(877) 632-6637
(708) 409-5179
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085008407
IL
363A00000X
Physician Assistant
10004381A
IN
Other
Enumeration date
06/01/2020
Last updated
05/15/2024
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