Healthcare Provider Details

I. General information

NPI: 1235182791
Provider Name (Legal Business Name): STEVEN HERWICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE DEPT OF RADIOLOGY - LOWER LEVEL
CHICAGO IL
60657
US

IV. Provider business mailing address

836 W WELLINGTON AVE DEPT OF RADIOLOGY - LOWER LEVEL
CHICAGO IL
60657
US

V. Phone/Fax

Practice location:
  • Phone: 847-438-0181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number036106709
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036106709
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: