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NPI Code Detail

MEDICARE: STEPHEN PERSELL MD

MEDICARE:   STEPHEN  PERSELL  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
1207R00000XInternal Medicine Physician036109493IL

General Provider Information

NPI Number : 1831124585
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN PERSELL MD
Provider Business Mailing Address
First Line : 750 N LAKE SHORE DR FL 10TH
Second Line :
City : CHICAGO
State : IL
Zip : 60611-4550
Country : US
Telephone Number : 312-503-6464
Fax Number :
Provider Business Practice Location Address
First Line : 675 N SAINT CLAIR ST STE 18-200
Second Line :
City : CHICAGO
State : IL
Zip : 60611-5929
Country : US
Telephone Number : 312-695-8630
Fax Number : 312-695-2857
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 11/12/2019

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Directions to “ STEPHEN PERSELL MD” Practice Location

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