Healthcare Provider Details

I. General information

NPI: 1366435901
Provider Name (Legal Business Name): STEPHEN C MIFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 W FOSTER AVE #311
CHICAGO IL
60625-3500
US

IV. Provider business mailing address

2740 W FOSTER AVE #311
CHICAGO IL
60625-3500
US

V. Phone/Fax

Practice location:
  • Phone: 773-907-7017
  • Fax: 773-907-7016
Mailing address:
  • Phone: 773-907-7017
  • Fax: 773-907-7016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036085126
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: