Healthcare Provider Details

I. General information

NPI: 1144227737
Provider Name (Legal Business Name): STEVEN RUSSELL BOAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/30/2024
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 WAUKEGAN RD STE 200
NORTHFIELD IL
60093-2743
US

IV. Provider business mailing address

191 WAUKEGAN RD STE 200
NORTHFIELD IL
60093-2743
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 TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036091411
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036091411
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number036091411
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: