MEDICARE: STEVEN J. DEANGELES, M.D., S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01635312	OTHER	IL	BLUE CROSS / BLUE SHIELD

General Provider Information

NPI Number	:	1104802370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN J. DEANGELES, M.D., S.C.

Provider Business Mailing Address
First Line	:	200 S MICHIGAN AVE
Second Line	:	SUITE 830
City	:	CHICAGO
State	:	IL
Zip	:	60604-2402
Country	:	US
Telephone Number	:	312-922-2500
Fax Number	:	312-922-2523

Provider Business Practice Location Address
First Line	:	200 S MICHIGAN AVE
Second Line	:	SUITE 830
City	:	CHICAGO
State	:	IL
Zip	:	60604-2402
Country	:	US
Telephone Number	:	312-922-2500
Fax Number	:	312-922-2523

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DR. STEVEN J DEANGELES
Credential	:	MD
Telephone Number	:	312-922-2500

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	08/28/2013

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