Provider Demographics
NPI:1871604876
Name:STEVENS, BERNARD (MD)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PHILLIP ROAD
Mailing Address - Street 2:SUITE 1108
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1700
Mailing Address - Country:US
Mailing Address - Phone:847-367-0843
Mailing Address - Fax:847-362-0647
Practice Address - Street 1:6 PHILLIP ROAD
Practice Address - Street 2:SUITE 1108
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1700
Practice Address - Country:US
Practice Address - Phone:847-367-0843
Practice Address - Fax:847-362-0647
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D14409Medicare UPIN
654430Medicare ID - Type Unspecified