1851301865 NPI number — MR. MARTIN STEVENS PT

Table of content: MR. MARTIN STEVENS PT (NPI 1851301865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851301865 NPI number — MR. MARTIN STEVENS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEVENS
Provider First Name:
MARTIN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

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:
1851301865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 E STATE PKWY
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
SCHAUMBURG
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60173-4569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-285-8007
Provider Business Mailing Address Fax Number:
630-285-8017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 WELLINGTON AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
ELK GROVE VILLAGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60007-7332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-437-7070
Provider Business Practice Location Address Fax Number:
847-437-1080
Provider Enumeration Date:
08/09/2006

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: 225100000X , with the licence number:  070-011337 , 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)





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