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Individual

MS. STEPHANIE SUMMERS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1594 KENILWORTH DR, CALUMET CITY, IL 60409-6306
(773) 425-8243
(773) 667-9622
Mailing address
1594 KENILWORTH DR, CALUMET CITY, IL 60409-6306
(773) 425-8243
(773) 667-9622

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
S56278166683
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
343729196040901
IL
Enumeration date
05/05/2008
Last updated
05/05/2008
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