Provider Demographics
NPI:1194885574
Name:THORNTON, STEVEN LEROY (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:LEROY
Last Name:THORNTON
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 1:7317 N WILLOW LAKE CT
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-8260
Mailing Address - Country:US
Mailing Address - Phone:309-683-7373
Mailing Address - Fax:309-691-4408
Practice Address - Street 1:7317 N WILLOW LAKE CT
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-8260
Practice Address - Country:US
Practice Address - Phone:309-683-7373
Practice Address - Fax:309-691-4408
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID036090726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL809840OtherMEDICARE GROUP #
ILR01609Medicare PIN
IL809840OtherMEDICARE GROUP #