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NPI Code Detail

MEDICARE: DR. STEPHEN C DOUGHTY MD

MEDICARE: DR. STEPHEN C DOUGHTY MD
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
1207RI0200XInfectious Disease Physician036-055284IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255327631
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STEPHEN C DOUGHTY MD
Provider Business Mailing Address
First Line : 901 MCCLINTOCK DR
Second Line : SUITE 202
City : BURR RIDGE
State : IL
Zip : 60527-0872
Country : US
Telephone Number : 888-220-6432
Fax Number : 630-654-4253
Provider Business Practice Location Address
First Line : 1120 E WAR MEMORIAL DR
Second Line :
City : PEORIA HEIGHTS
State : IL
Zip : 61616-7757
Country : US
Telephone Number : 888-220-6432
Fax Number : 630-654-4253
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 05/13/2015

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