Healthcare Provider Details

I. General information

NPI: 1922142223
Provider Name (Legal Business Name): EVAN STEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE STE MC6080
CHICAGO IL
60637-1641
US

IV. Provider business mailing address

150 HARVESTER DR STE 300
BURR RIDGE IL
60527-5965
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1061
  • Fax:
Mailing address:
  • Phone: 773-702-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036140942
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number35-041267
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: