MEDICARE: STEVEN ANDERSON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036073487	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	950150012	OTHER	IL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01621679	OTHER	IL	BCBS OF IL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386620227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN ANDERSON DO

Provider Business Mailing Address
First Line	:	2525 S MICHIGAN AVE
Second Line	:	MEDICAL STAFF OFFICE
City	:	CHICAGO
State	:	IL
Zip	:	60616-2315
Country	:	US
Telephone Number	:	312-567-7924
Fax Number	:	312-567-6189

Provider Business Practice Location Address
First Line	:	47 W POLK ST
Second Line	:	STE: G1
City	:	CHICAGO
State	:	IL
Zip	:	60605-2000
Country	:	US
Telephone Number	:	312-922-3409
Fax Number	:	312-583-1712

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	03/14/2016

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Directions to “ STEVEN ANDERSON DO” Practice Location

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