Healthcare Provider Details

I. General information

NPI: 1780748483
Provider Name (Legal Business Name): STEVEN BOYCE COKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD
WINFIELD IL
60190-1295
US

IV. Provider business mailing address

900 JORIE BLVD STE 220
OAK BROOK IL
60523-2213
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-6631
  • Fax: 630-933-4936
Mailing address:
  • Phone: 630-645-9900
  • Fax: 630-645-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number036065689
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number036065689
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: