Healthcare Provider Details

I. General information

NPI: 1386797843
Provider Name (Legal Business Name): STEPHEN LAWRENCE ARCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE MAIL CODE 6080, UNIVERSITY OF CHICAGO
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

350 OLSEN CLOSE
EDMONTON ALBERTA
T6R 1L1
CA

V. Phone/Fax

Practice location:
  • Phone: 773-834-9748
  • Fax: 773-702-8875
Mailing address:
  • Phone: 780-407-3463
  • Fax: 780-407-3489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number36117433
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: