Healthcare Provider Details

I. General information

NPI: 1720053077
Provider Name (Legal Business Name): STEPHEN M PLATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 STATE ST
CHESTER IL
62233-1116
US

IV. Provider business mailing address

1900 STATE ST
CHESTER IL
62233-1116
US

V. Phone/Fax

Practice location:
  • Phone: 618-826-4581
  • Fax:
Mailing address:
  • Phone: 618-826-4581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036051292
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.051292
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: