Healthcare Provider Details

I. General information

NPI: 1699772996
Provider Name (Legal Business Name): STEPHEN J. HOUDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KISH HOSPITAL DRIVE
DEKALB IL
60115-9602
US

IV. Provider business mailing address

1 KISH HOSPITAL DRIVE
DEKALB IL
60115-9602
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-1521
  • Fax: 815-748-8395
Mailing address:
  • Phone: 815-756-1521
  • Fax: 815-748-8395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036098010
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.098010
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number336.059958
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: