Healthcare Provider Details

I. General information

NPI: 1598941627
Provider Name (Legal Business Name): STEVEN L CICIORA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S YORK ST STE 3190
ELMHURST IL
60126-5628
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 331-221-9275
  • Fax:
Mailing address:
  • Phone: 847-570-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number036177189
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: