Healthcare Provider Details

I. General information

NPI: 1033183363
Provider Name (Legal Business Name): MICHAEL D STOVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST FL 13
CHICAGO IL
60611-3926
US

IV. Provider business mailing address

676 N. ST. CLAIR SUITE 1350 NORTHWESTERN MEDICAL FACULTY FOUNDATION
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-6800
  • Fax: 312-695-2772
Mailing address:
  • Phone: 312-695-5902
  • Fax: 312-695-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036-098815
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number36098815
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: