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NPI Code Detail

MEDICARE: STUART M SPRAGUE DO

MEDICARE: STUART M SPRAGUE DO
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
1207RN0300XNephrology Physician036066785IL

General Provider Information

NPI Number : 1114947124
Entity Type Code : Individual
Provider Name (Legal Business Name) : STUART M SPRAGUE DO
Provider Business Mailing Address
First Line : 1000 CENTRAL ST STE 800
Second Line :
City : EVANSTON
State : IL
Zip : 60201-1780
Country : US
Telephone Number : 847-570-2512
Fax Number : 847-570-1696
Provider Business Practice Location Address
First Line : 1000 CENTRAL ST STE 800
Second Line :
City : EVANSTON
State : IL
Zip : 60201-1780
Country : US
Telephone Number : 847-570-2512
Fax Number : 847-570-1696
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 04/01/2021

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Directions to “ STUART M SPRAGUE DO” Practice Location

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