Healthcare Provider Details

I. General information

NPI: 1659538213
Provider Name (Legal Business Name): STEVEN R BOAS MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 RAVINE WAY STE 302
GLENVIEW IL
60025-7645
US

IV. Provider business mailing address

2401 RAVINE WAY STE 302
GLENVIEW IL
60025-7645
US

V. Phone/Fax

Practice location:
  • Phone: 847-998-3434
  • Fax: 847-998-8584
Mailing address:
  • Phone: 847-998-3434
  • Fax: 847-998-8584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number036091411
License Number StateIL

VIII. Authorized Official

Name: DR. STEVEN RUSSELL BOAS
Title or Position: PULMONOLOGIST
Credential: MD
Phone: 847-998-3434