Healthcare Provider Details

I. General information

NPI: 1851119572
Provider Name (Legal Business Name): STEPHEN HOLTSFORD ENTERPRISES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3N845 EMILY DICKINSON LN
ST CHARLES IL
60175-7797
US

IV. Provider business mailing address

3N845 EMILY DICKINSON LN
ST CHARLES IL
60175-7797
US

V. Phone/Fax

Practice location:
  • Phone: 630-881-5698
  • Fax:
Mailing address:
  • Phone: 630-881-5698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN R HOLTSFORD
Title or Position: OWNER
Credential: MD
Phone: 630-881-5698