Healthcare Provider Details

I. General information

NPI: 1366736654
Provider Name (Legal Business Name): STEPHEN DAVID HURLEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W NORTH AVE STE 201
MELROSE PARK IL
60160-1600
US

IV. Provider business mailing address

675 W NORTH AVE STE 605
MELROSE PARK IL
60160-1634
US

V. Phone/Fax

Practice location:
  • Phone: 708-450-5055
  • Fax: 708-338-2474
Mailing address:
  • Phone: 708-450-5055
  • Fax: 708-338-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036140340
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: