Healthcare Provider Details

I. General information

NPI: 1952622649
Provider Name (Legal Business Name): WHITNEY W. STEVENS M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST 18TH FLOOR SUITE 250
CHICAGO IL
60611-5975
US

IV. Provider business mailing address

680 N LAKE SHORE DR SUITE 1000
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8624
  • Fax: 312-695-3136
Mailing address:
  • Phone: 312-695-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036133320
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036133320
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: