Healthcare Provider Details

I. General information

NPI: 1588927065
Provider Name (Legal Business Name): STEPHEN CURRIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 VALLEY VIEW DR STE 202
MOLINE IL
61265
US

IV. Provider business mailing address

510 S KINGSHIGHWAY BLVD MIR CAMPUS BOX 8131
SAINT LOUIS MO
63110-1016
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-1072
  • Fax: 309-762-1094
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number45266
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number69346-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2017008995
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-145703
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: