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NPI Code Detail

MEDICARE: SAMANTHA ANNE STEPHEN DO

MEDICARE: SAMANTHA ANNE STEPHEN 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
1390200000XStudent in an Organized Health Care Education/Training Program
2390200000XStudent in an Organized Health Care Education/Training ProgramIL

General Provider Information

NPI Number : 1154958346
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA ANNE STEPHEN DO
Provider Business Mailing Address
First Line : 2121 W HARRISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3705
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2121 W HARRISON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3705
Country : US
Telephone Number : 312-666-0500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2020
Last Update Date : 06/17/2024

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Directions to “ SAMANTHA ANNE STEPHEN DO” Practice Location

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