Provider Demographics
NPI:1104802370
Name:STEVEN J. DEANGELES, M.D., S.C.
Entity type:Organization
Organization Name:STEVEN J. DEANGELES, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEANGELES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-922-2500
Mailing Address - Street 1:200 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 830
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-2402
Mailing Address - Country:US
Mailing Address - Phone:312-922-2500
Mailing Address - Fax:312-922-2523
Practice Address - Street 1:200 S MICHIGAN AVE
Practice Address - Street 2:SUITE 830
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-2402
Practice Address - Country:US
Practice Address - Phone:312-922-2500
Practice Address - Fax:312-922-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635312OtherBLUE CROSS / BLUE SHIELD
211766Medicare ID - Type Unspecified