1538405931 NPI number — MR. STEPHEN M SOLUM PA-C

Table of content: MR. STEPHEN M SOLUM PA-C (NPI 1538405931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538405931 NPI number — MR. STEPHEN M SOLUM PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLUM
Provider First Name:
STEPHEN
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1538405931
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 COMMERCE CT
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
LISLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60532-3698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-968-1881
Provider Business Mailing Address Fax Number:
630-968-1719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 OGDEN AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60504-4273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-968-1881
Provider Business Practice Location Address Fax Number:
630-968-1719
Provider Enumeration Date:
12/13/2012

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: 363A00000X , with the licence number:  085004570 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AS0400X , with the licence number: 085004570 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 970023229 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 085004570 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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