Provider Demographics
NPI:1386620227
Name:ANDERSON, STEVEN (DO)
Entity type:Individual
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First Name:STEVEN
Middle Name:
Last Name:ANDERSON
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Gender:M
Credentials:DO
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Mailing Address - Street 1:2525 S MICHIGAN AVE
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2315
Mailing Address - Country:US
Mailing Address - Phone:312-567-7924
Mailing Address - Fax:312-567-6189
Practice Address - Street 1:47 W POLK ST
Practice Address - Street 2:STE: G1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2000
Practice Address - Country:US
Practice Address - Phone:312-922-3409
Practice Address - Fax:312-583-1712
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2016-03-14
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Provider Licenses
StateLicense IDTaxonomies
IL036073487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621679OtherBCBS OF IL
IL036073487Medicaid
IL950150012OtherMEDICARE PTAN
IL01621679OtherBCBS OF IL